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«84 



UNITED STATES OF AMERICA. 



A PRACTICAL TREATISE 



ON 



MATEKIA MEDICA 



AND 



THERAPEUTICS. 



BY 



EOBEETS BAETHOLOW, M.A., M.D., LL.D., 

PROFESSOR OF MATERIA MEDICA AND GENERAL THERAPEUTICS IN THE JEFFERSON MEDICAL 
COLLEGE OP PHILADELPHIA, ETC. 







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7^ 



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FIFTH EDITION, REVISED AND ENLARGED. 



NEW YOEK : 
D. APPLETON AND COMPANY, 

1, 3, and 5 BOND STEEET. 

1884. 



x<V N 






COPYRIGHT BY 

D. APPLETON AND COMPANY 

1876, 1877, 1879, 1881, 1883. 



TO THE MEMORY OF 

FATHER, MOTHER, AND BROTHERS, 

BY THE SUE VI VO E. 



PREFACE TO THE FIFTH EDITION. 



The appearance of the sixth decennial revision of the " United 
States Pharmacopoeia " has imposed on me the necessity of pre- 
paring a new edition of this treatise. I have accordingly adapted 
the work to the official standard, and have also given to the whole 
of it a careful revision, incorporating the more recent improve- 
ments in the science and art of therapeutics. Many additions 
have been made, and parts have been rewritten. These additions 
and changes have added about one hundred pages to the body 
of the work, and increased space has been secured in some places 
by the omission of the references. In the new material, as in the 
old, practical utility has been the ruling principle, but the scien- 
tific aspects of therapeutics have not been subordinated to a utili- 
tarian empiricism. In the new matter, as in the old, careful 
consideration has been given to the physiological action of reme- 
dies, which is regarded as the true basis of all real progress in 
therapeutical science; but, at the same time, I have not been un- 
mindful of the contributions made by properly conducted clinical 
observations. 

The improvements made in this edition render the work more 
than heretofore better fitted to occupy the place to which it has 
been assigned by the generous estimate of the medical profession. 
I should be singularly wanting in a proper feeling, if, in sending 
forth another issue of the work, I did not experience a grateful 
sense of appreciation for the uniformly kindly reception accorded 
to this and to my other publications. 

Roberts Bautholow. 

Philadelphia, September, 1883. 



PREFACE TO THE FOURTH EDITION. 



Engagements that admitted of no postponement prevented 
the preparation of the fourth edition of this work at an earlier 
period. Meanwhile, the activity prevailing on all sides in the 
study of experimental and practical therapeutics has contributed 
many new and important facts to this expanding science. New 
remedies, studied by the physiological method, are presented to 
us in the fullest detail of their actions, and old ones are exam- 
ined anew in the brilliant light of modern scientific methods. 
Subjected to the strictest physiological tests, remedies are pur- 
sued into the closest recesses of Nature, their powers fully ascer- 
tained, and their uses suggested from the standpoint of their 
physiological actions. The old facts thus receive sifting and re- 
examination, and, with the new, demand recognition and ade- 
quate statement. It follows, that any therapeutical treatise which 
would keep pace with the progress of knowledge must be fre- 
quently renewed, amended, and improved. Appreciating fully the 
necessity for this periodical revision of my treatise, I have care- 
fully reviewed the acquisitions of the period intervening since the 
publication of the last edition, and have in the present edition in- 
corporated those improvements in our therapeutical resources which 
seem to be of permanent value. I have revised the text at all 
points, have rewritten many articles, made important additions to 
others, and have inserted, for the first time, the articles on Ba- 
rium, Nitro-glyceriri, Curara, Muscarine, Resorcin, etc. The 
group Antiseptics has been transferred to a more appropriate 
position, among the systemic remedies. The growing importance 
in modern pathology of the germ theory requires this group 
ing of certain remedies possessing the power to destroy the mi- 



PREFACE TO THE FOURTH EDITION. v ii 

nute organisms of disease, and to arrest septic processes. These 
properties are sufficiently distinctive to require their recognition in 
a separate group; but, in addition, the remedies composing this 
group have antipyretic effects. It has been suggested that the 
antiseptic action is the source of the antipyretic — that in the 
destruction of germs, or morbific ferments, lies the power to 
arrest the excess in heat-production. 

Notwithstanding the numerous and important additions to 
the work, the number of pages has been increased only about 
seventy. In several instances important additions have been 
made, without any increase of space, by the sacrifice of the ref- 
erences. In the rewriting of old articles and in the preparation 
of the new, the utmost conciseness consistent with clearness and 
accuracy has been the ruling principle. True to the idea ex- 
pressed in the first edition, I have, as far as possible, accepted 
the results of physiological research, but have not ignored the 
facts obtained empirically. Unquestionably, the tide of thera- 
peutical knowledge sets strongly in the direction indicated by the 
former, and the latter is as distinctly ebbing outward. On all 
sides the conviction is growing, that the real and permanent 
advances in therapeutical art must be effected chiefly by the 
physiological method. Nevertheless, empirical facts of undoubted 
value are occasionally brought forward. In "the shapeless mass 
of inexact ideas," as Bichat entitled empirical observations, there 
are often found genuine therapeutical gems. 

Besides the careful revision given to the whole work, I have 
rewritten the "Clinical Index," with a view to the addition of 
new matter, and to secure greater accuracy of expression. Pre- 
scriptions which heretofore had a place in this index, and were 
transcribed from the body of the work, have been omitted, as 
their repetition seemed unnecessary, and gave opportunity for 
serious errors. The page reference permits the easy finding of a 
formula, and in the search the context will be read, so that with 
the prescription will be obtained needful explanations. 

In submitting this edition to my professional colleagues, I am 
again afforded the grateful opportunity to express my sincere ap- 
preciation of the favor with which each formal edition has been 



v iii PREFACE TO THE FOURTH EDITION. 

received. I must also repeat my acknowledgments to the kind 
correspondents who have informed me of errors, textual and typo- 
graphical, coming under their notice, and I now thank in advance 
any one of my readers who, observing an error of any kind, will 

inform me of it. 

K. B. 
Philadelphia, September 1, 1881. 



PREFACE TO THE THIED EDITION. 



In the preparation of this edition, I have made changes de- 
manded by the progress of knowledge, have omitted obsolete or 
unnecessary statements, and have added some entirely new articles. 
As examples of the additions made, I may mention the articles on 
Air, Massage, and Dnboisia. The text has been thoroughly revised, 
and typographical and other errors corrected. Notwithstanding 
considerable additions, the volume is kept nearly within its original 
limits, by condensing the new material to the lowest point consist- 
ent with clearness of statement and fullness and accuracy of infor- 
mation. 

The rapid sale of successive editions of the work is the most 
conclusive evidence of its adaptation to the needs of students and 
practitioners. To make it still more worthy of their approval has 
been my constant endeavor, as the best and most appropriate ex- 
pression of my gratitude for the extraordinary favor with which 
the treatise has been regarded since its first appearance. 

E. B. 

1509 Walnut Street, Philadelphia. 



PREFACE TO THE SECOND EDITION. 



The success of my treatise has exceeded any reasonable ex- 
pectations, and, under the circumstances, is peculiarly gratifying. 
Constructed on a somewhat different plan from the ordinary text- 
books, and brought into direct competition with several very able 
and well-established works on the same subject, I could not but 
feel that its progress to professional favor must necessarily be 
slow. That several considerable editions have been exhausted in 
the first year of its publication, and that the demand for the 
book has not abated, indicate that its appearance was opportune, 
and that its plan and execution are approved by the medical 
profession. 

In this new edition various improvements have been made, 
and articles on the following subjects have been inserted : 



Beverages. 


Heat. 


Digesti on-Ferm ents. 


Vegetable Acids. 


Cadmium. 


Cerium. 


Picrotoxin. 


Cannabis Indica. 


Cuca. 


Caffein. 


Guarana. 


Pulsatilla. 


Grindelia. 


Phytolacca. 


Ailanthus. 



Besides the new articles, additions have been made at various 
points. Notwithstanding these additions, the bulk of the work 
has not been materially increased, and its practical character has 
been strictly maintained. 

Increasing observation satisfies me that an author, writing on 
such a complicated topic as the actions and uses of remedies, 
owes it to his readers to present them the results of his matured 
experience and his most composed judgment, rather than lay be- 
fore them a multitude of opinions, experiments, and reports, out 
of which they must construct, if they can, a consistent theory, 



PREFACE TO THE SECOND EDITION. x i 

or form an adequate conception of the nature and relations of 
all the facts. But few readers will give the time to so tedious 
a task, and the smallest number are fitted by education, training, 
and habits of mind, for working out results from such a com- 
plicated mass of materials. While every author is bound to in- 
dicate to his readers the sources of his information, it is equally 
his duty to present that information in the form most available 
for immediate use. 

The classification of remedies must continue in an unsatisfac- 
tory state, and any scientific scheme is, at present, hopeless. The 
distinguished and able Prof. Edward H. Clark, M. D., of Har- 
vard (Boston), in his review of this work {The American Jour- 
nal of the Medical Sciences, January 7, 1877), justly remarks as 
follows : 

" No scientific classification of the materia medica is possible in the present 
state of science. Writers are, therefore, justified in adopting any classifica- 
tion that may happen to suit their fancy, or in adopting none at all." 

Notwithstanding a scientific arrangement is unattainable, it is 
certainly convenient to group together those agents which are 
physiologically and therapeutically allied. I have adopted, in part, 
the classification proposed, in 1863, by Dr. Chambers ("Kenewal 
of Life," etc.), using the two great divisions of "agents promot- 
ing constructive metamorphosis " and " agents promoting destruc- 
tive metamorphosis.'" As respects the assignment of individual 
remedies, in accordance with certain conceptions of their powers 
and actions, the arrangement adopted is entirely my own. 

The omission of certain botanical, chemical, and pharmaceuti- 
cal details, except such as are necessary to a just appreciation 
of the physiological actions, or to "facilitate intelligent prescrip- 
tion-writing," has been decidedly commended by the reviewers, 
and by my readers generally. In the present state of pharmacy, 
knowledge of the kind omitted would prove useless, in the main, 
to physicians, even if acquired. I beg, however, to call the at- 
tention of my readers to the fact that the official designation of 
the remedy, its pharmaceutical preparations, its chemical compo- 
sition, and its active principles, are carefully stated, and should 
be mastered by every student. This knowledge of the technik 



xii PREFACE TO THE SECOND EDITION. 

of his armamentarium is an indispensable requisite to its skill- 
ful use. 

The author has a strong conviction that, in the future of thera- 
peutics, the law or principle of physiological antagonism must 
play an important rdle. He has indicated more fully, probably, 
than any other systematic writer, the application of this principle 
in practical therapy. 

In the preparation of the articles I have studiously endeavored 
to preserve the harmony and proportion of the parts, and have 
treated them with a fullness and particularity according to their 
relative importance. In this way it may appear to some of my 
readers that I have exaggerated some topics, and have treated 
others, equally important, with indifference. Having given careful 
consideration to this subject in the course of my preparations for 
the new edition, I conclude that the judgments formed in the first 
instance are confirmed by more extended study and observation. 

Any one discovering an error of any kind in this edition of 
my treatise will place me under great obligations by reporting it 
to me without delay. 

I am indebted to my assistant, Dr. Frederic Kebler, for the 
revision of the indexes. 

KOBEKTS BARTHOLOW. 
120 West Seyenth Street, Cincinnati. 



PREFACE TO THE FIRST EDITION. 



To offer to the medical profession a new treatise on Materia 
Medica and Therapeutics may appear to be a labor of supereroga- 
tion. The medical literature of this country is already well pro- 
vided with able and elaborate works on this subject. The learned 
and encyclopedic volumes of Still e, based on the empirical method, 
and the modern and scientific work of H. C. Wood, based on the 
physiological method, leave almost nothing to be desired. Enter- 
taining such a profound respect for the work of my American 
colleagues, it may well be inquired why I have ventured to add a 
new book to those already existing in this department of medical 
knowledge. A belief, which I trust will not be regarded as ego- 
tism, that I have earned the right to address the medical profession, 
has moved me to the preparation of this work. Several years a 
teacher of Materia Medica and Therapeutics, I have necessarily 
formed opinions as to the kind of information which should be 
contained in a treatise on this subject. As far as such a course of 
experiment is practicable, I have demonstrated in my lectures the 
actions of remedies on animals. I have conducted in my private 
laboratory many independent investigations, and have contributed 
in this way, I submit with diffidence, some original knowledge to 
the subject of therapeutics. The information thus acquired has 
been supplemented by twenty-two years of clinical experience as 
a practitioner of medicine. Under these circumstances, I am in- 
duced to believe that my professional brethren, and medical stu- 
dents, will hold that I am entitled to a hearing. 

A volume on Materia Medica and Therapeutics should, in these 
days, present some new features of importance if it would worthily 
occupy a place alongside of the excellent works now accessible to 
American readers. An examination of this treatise will disclose the 
fact that it differs from other works in its scheme of classification, 



xiv PREFACE TO THE FIRST EDITION. 

in the subjects discussed, and in the very practical character of the 
information. In the present state of our knowledge, it is impossible 
to make a classification free from defects, and I do not claim for 
mine that it is superior to others — only that its simplicity is a point 
in its favor. As respects the subjects treated of, it will be seen that 
the most elaborate section is that on aliment, and that remedies have 
been introduced not usually referred to by therapeutical writers. 
In the treatment of individual agents, I have, usually, adopted the 
description of the " United States Pharmacopoeia," and have omitted 
botanical and chemical details, unless they are necessary to elucidate 
physiological questions, or to facilitate intelligent prescription-writ- 
ing. All pharmaceutical questions are most thoroughly handled in 
the "Dispensatory" of Wood and Bache, and this kind of knowl- 
edge is more the province of the druggist than of the physician. 

In describing the physiological action of drugs, two methods 
may be pursued : to present in chronological order a summary of 
the opinions of various authorities on the subject in question ; or, 
to condense in a connected description that view of the subject 
which seems to the author most consonant with all the facts. I have 
adopted the latter plan, from a conviction of its advantages for the 
student, and of its utility for the practitioner. The authorities 
which I have utilized in making up my opinions are placed at the 
end of each article, in order to avoid interruptions in the methodical 
descriptions. 

As respects the therapeutical applications of remedies, I have, as 
far as practicable, based them on the physiological actions. Many 
empirical facts are, however, well founded in professional experience. 
Although convinced that the most certain acquisitions to therapeu- 
tical knowledge must come through the physiological method, I am 
equally clear that well-established empirical facts should not be 
omitted, even if they are not explicable by any of the known physi- 
ological properties of the remedies under discussion. 

My best acknowledgments are due to John Chatto, Esq., the 
learned Librarian of the Royal College of Surgeons, London, for 
numerous courtesies extended to me during my visits to Lincoln's- 
Inn-Fields. Roberts Bartholow. 



120 West Seventh Street, 
Cincinnati, Ohio, June, 1876 



I 



TABLE OF CONTENTS 



Schema 



PAGE 

1 



PART I. 

Routes by which Medicines are introduced into the Organism 

1. Through the External Integument . 

2. Through the Internal Integument 

3. By the Subcutaneous Areolar Tissue 

4. By the Veins .... 

Transfusion of Blood 
Arterial Transfusion . 
Transfusion of Milk 
Peritoneal Transfusion 

PART II. 

The Actions and Uses of Remedial Agents 
Those used to promote Constructive Metamorphosis 
Aliments 
Animal 
Vegetable . 
Special Plans of Diet 
Denutrition 
Dry Diet 
Vegetable Diet 
Milk Diet 
Infant Feeding 
Alimentation in Diseases . 

Aliment in Acute Inflammations and Fevers 
Formulae for Animal Broths 
Formulae for Diet Drinks 
Aliment in Diseases of the Digestive Organs 
Aliment in Cachectic States 

Formulae for Articles of Diet 
Nutrient Enemata 

Supplementary Rectal Alimentation 
Beverages ; 

Coffee ..... 
Tea . 

Cocoa ..... 
Milk 



4 
11 

15 
16 
19 
20 
21 



23 
23 

23 
25 
34 
38 
38 
41 
42 
44 
47 
49 
49 
50 
50 
51 
52 
54 
55 
56 
57 
57 
57 
57 
59 



XVI 



TABLE OF CONTENTS. 



Water .... 
Aqua .... 
Fluvialis . 
Fontana 
Modes of applying Water 
Kussian Bath 
The Wet Pack . 
The Douche . 
The Hip or Sitz Bath 
Hydrotherapy 
Heat .... 

Modes of applying Heat . 
Solar Heat 
Artificial Heat 
Moist Heat 
Dry Heat 
The Turkish Bath 
Air ..... 
Pure Air 
Impure Air 
Compressed Air 

Therapy of Compressed Air . 
Massage .... 
Digestion Ferments 
Pepsin 

Ingluvin .... 
Pancreatin 
Papaiva or Papain 
Acidum Lacticum . 
Acids, Mineral .... 
Oils and Fats 

Phosphorus and some of its Compounds 
Phosphites and Phosphates 
Iron and its Preparations 
Manganesium 

Chalybeate Mineral Springs 
Bismuth .... 
Arsenic .... 

The Simple Bitters . 
Aromatic Bitters 

Eucalyptus .... 
Hydrastis .... 

Cinchona and its Preparations 
Agents promoting Destructive Metamorphosis or 
Alkalies .... 
Potassium and its Preparations . 
Sodium and its Preparations . 
Calcium and its Preparations 
Lithium and its Preparations . 
Alkaline Mineral Springs 
Saline Mineral Springs . 
Ammonium and its Preparations . 



increasing 



Waste 



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92 

99 

103 

110 

119 

123 

136 

139 

141 

144 

157 

161 

164 

165 

167 

187 

187 

187 

195 

197 

199 

203 

206 

210 



TABLE OF CONTENTS. 



xvn 



Barium and its Preparations ....... 


215 


Vegetable Acids ........ 


218 


Sulphurous Acid and the Sulphides ...... 


220 


Sulphur and Sulphides (Sulphurets) . . . . . 


222 


Sulphurous Mineral Waters ...... 


224 


Iodine and its Preparations . . . . . . 


227 


Ether Hydriodicus ........ 


238 


Iodoformum ........ 


239 


Mercury and its Preparations ...... 


244 


Aurum (Gold) and its Preparations ..... 


258 


Argentum (Silver) and its Preparations ..... 


260 


Cuprum (Copper) and its Preparations ..... 


268 


Plumbum (Lead) and its Preparations ..... 


272 


Zincum (Zinc) and its Preparations ..... 


278 


Antimonium (Antimony) and its Preparations .... 


283 


Cadmium, Sulphate . . . . . . . 


287 


Cerium, Oxalate ........ 


288 


Metallotherapy ........ 


289 


Alumen (Alum) and its Preparations ..... 


292 


Acidum Tannicum ....... 


296 


Acidum Gallicum ........ 


296 


Galla (Nutgall) 


296 


Catechu ......... 


296 


Kino ......... 


297 


Krameria (Rhatany) . . . . 


297 


Haematoxylon (Logwood) ...... 


297 


Geranium (Cranesbill) ....... 


297 


Quercus Alba (White Oak) ...... 


297 


Quercus Tinctoria (Black Oak) . . . 


297 


Rosa Gallica (Red Rose) ....... 


298 


Rubus (Blackberry) ........ 


298 


Myrica Cerifera (Bayberry) ...... 


298 


Alnus Serrulata (Alder) ....... 


298 


Statice Limonium (Marsh Rosemary) . • . 


298 


Heuchera (Alum-Root) ....... 


298 


Hamamelis Virginica (Witch-Hazel) ..... 


298 


Nymphsea Odorata . . . . . . . . 


299 


Castanea Vesca ........ 


299 


Colchicum and its Preparations ...... 


304 


Sarsaparilla and its Preparations ..... 


307 


Guaiacum and its Preparations ...... 


309 


Stillingia and its Preparations ...... 


310 


Sanguinaria (Blood-Root) ....... 


312 


Xanthoxylum ........ 


315 


Fraxinus Americana ........ 


316 


Agents having the Power to arrest Septic Processes, and to destroy the Ferments 




or the Minute Organisms (Disease-Germs) on the Presence of which their 




Activity depends ........ 


317 


Antiseptics ......... 


317 


Oxygen . 


318 


Chlorine ......... 


320 


Bromine ......... 


321 



XV111 



TABLE OF CONTENTS. 



Carbolic Acid 
Creosote . 

Sulphocavbolates 
Salix 
Salicine 
Salicylic Acid 
Resorcin 
Boracic Acid 
Benzoin 

Benzoates 
Antiseptic Oils 

Gaultheria . 

Thyme . 

Cajeput 

Thymol . 

Myrtol 
Agents used to modify the Functions of the Nervous System 

Agents whose most Important Quality consists in exciting Functional 

A. Of the Spinal Cord and Sympathetic 
Electricity 
Static Electricity . 
Magnetism 
Galvanism 
Faradism 

Electro-Physiology 
Electro-Diagnosis 

Therapy 

Electrolysis 

Galvano-Cautery 

Static Electricity. 

Trouve's Polyscope . 
Nux Vomica and its Preparations 

Strychnine .... 

Hypodermatic Injection of Strychnine 

Ignatia .... 

Cocculus 
Picrotoxin .... 

Ergota (Ergot) and its Preparations . 

Hypodermatic Injection of Ergotin . 
Ustilago Maydis (Corn-Ergot) 
Digitalis and its Preparations 
Convallaria .... 
Cimicifuga and its Preparations . 
Belladonna and its Preparations 

Atropine .... 

Atropine, Hypodermatic Injection of 

Homotropine 
Stramonium and its Preparations 
Hyoscyamus and its Preparations 

Hyoscine 
Duboisia ..... 

B. Agents exciting the Functional Activity of the Cerebrum 



Activity 



PAGE 

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322 

332 
334 
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351 
353 
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404 
404 
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408 
417 
420 
421 
429 
432 
434 
435 
443 
445 
446 
447 
451 
452 
454 



TABLE OF CONTENTS. 



xix 





PAGE 


Camphor and its Preparations ...... 


454 


Asafoetida and its Preparations ..... 


. 458 


Ammoniacum and its Preparations . . . . , . 


460 


Valerian and its Preparations . . . 


. 461 


Cannabis Indica ........ 


463 


Cannabis Americana ....... 


. 463 


Erythroxylon ........ 


466 


Caffeine ........ 


. 467 


Guarana ......... 


469 


Remedies which diminish or suspend the Functions of the Cerebrum after a Pi 


-e- 


liminary Stage of Excitement ..... 


. 470 


Alcohol ......... 


470 


Yinum (Wine) ....... 


. 480 


Beer, Ale, and Porter ....... 


485 


Extract of Malt ....... 


. 486 


Paraldehyde . . . . . . . . 


486 


jEther ......... 


. 487 


Ether Hypodermatically ....... 


490 


Chloroformum ........ 


. 491 


Chlorodyne ........ 


494 


Anaesthetics and Anaesthesia ...... 


. 495 


Ether and Chloroform ....... 


495 


Ethyl Bromide . . ... 


. 504 


Bichloride of Methylene ....... 


505 


Local Anaesthesia ....... 


. 506 


Nitrous Oxide. ........ 


507 


Chloral . . . . 


. 509 


Croton Chloral Hydrate ....... 


515 


Opium and its Preparations . . 


. 516 


Morphine and its Salts ....... 


518 


Humulus (Hops) ........ 


. 637 


Lupuline . 


537 


Lactucarium ........ 


. 538 


Bromides . . 


538 


Agents which depress the Motor Functions of the Spinal Cord and Sympathetic 


. 550 


Conium and its Preparations . . . . . . 


550 


Conine and Morphine ...... 


. 554 


Curara or Woorara ........ 


555 


Curarine . . 


. 555 


Gelsemium and its Preparations ...... 


559 


Arnica and its Preparations ...... 


. 564 


Trimethylamine . . . . . . . . 


565 


Pilocarpus (Jaborandi) ....... 


. 667 


Physostigma and its Preparations ...... 


573 


Tabacum (Tobacco) and its Preparations ..... 


. 579 


Lobelia and its Preparations . . . 


583 


Acidum Hydrocyanicum (Prussic Acid) ..... 


. 585 


Potassii Cyanidum . 


589 


Amyl Nitrite ......... 


. 591 


Nitro-glycerin . . • 


594 


Aconite and its Preparations ...... 


. 597 


Veratrum Viride and its Preparations ..... 


602 



XX 



TABLE OF CONTENTS. 



Pulsatilla and its Preparations 

Grindelia and its Preparations 

Phytolacca and its Preparations . 

Ailanthus 

Muscarine .... 

Quebracho 

Remedies used to cause some Evacuation from the Body 
Emetics ..... 

Emetics by Local Action 
Systemic Emetics 

Apomorphine .... 

Ipecacuanha and its Preparations . 
Cathartics ...... 

Laxatives .... 

Manna ..... 

Sulphur .... 

Pulvis Glycyrrhizse Compositus . 
Magnesia .... 

Oleum Ricini .... 

Saline Purgatives 

Sulphate of Magnesia 
Citrate of Magnesia . 
Mercurial Purgatives 

Calomel .... 

Massa Hydrargyri 
Tonic-Astringent and Resin-bearing Purgatives 
Senna and its Preparations 
Rheum and its Preparations 
Aloes and its Preparations 
Jalap and its Preparations . 
Scammony and its Resin 
Colocynth and its Preparations 
Podophyllum and its Preparations 
Leptandra .... 

Iris 

Euonymus . 
Baptisia 
Hydragogue Cathartics . 
Gamboge 
Croton-Oil . 
Elaterium 
Elaterin 
Enemata 
Anthelmintics 

Mucuna . 
Santonica 

Santonin 
Spigelia and its Preparations 
Chenopodium (Worm-Seed) 

Oleum Chenopodii 
Filix Mas (Male Fern) . 
Oleo-resina Filicis 



PAGE 

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610 
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619 
619 
619 
621 
621 
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TABLE OF CONTENTS. 



xxi 



Granati Fructus Cortex 

Brayera 

Kamala . 

Pepo (Pumpkin-Seeds) 
Urino-Genital Kemedies 
Oleum Terebinthinae . 
Copaiba and its Preparations 
Cubeb and its Preparations 
Piper 

Oleo-resina Piperis 
Capsicum and its Preparations 
Juniper and its Preparations 
Erigeron . 

Oieum Erigerontis 
Buchu and its Preparations 
Uva Ursi and its Preparations 
Pareira and its Preparations 
Chimaphila and its Preparations 
Scoparius . 
Carota 

Taraxacum and its Preparations 
Scilla and its Preparations 
Petroselinum 

Polygonum Eydropiperoides . 
Ruta 
Sabina 
Cantharis . 

Tinctura Cantharidis 



PART 

Topical Remedies 
Counter-irritants . 

Rubefacients 

Sinapis Alba 
Sinapis Nigra 

Charta Sinapis 

Emplastra 

Linimenta 

Epispastics 

Ceratum Cantharidis 
Ceratum Extracti Cantharidis 
Charta Cantharide 
Collodium cum Cantharidis 
Linimentum Cantharidis 

Acupuncture 

Baunscheidtismus 

Aquapuncture 

Bloodletting . 

Escharotics 

Acidum Chromicum 

Emollients, Protectives, and Demulcents 
Glycerin and its Preparations . 



II 



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XX11 



TABLE OF CONTENTS. 



Collodium .... 

Liquor Gutta-Percha 

Chondrus (Irish Moss) 

Cetraria (Iceland Moss) . 

Acacia and its Preparations . 

Tragacanth 

Mucilago Tragacanthae . 
Sassafras Medullae 

Mucilago Sassafras Medullae 
Linum (Flaxseed) and its Preparations 
Ulmus (Slippery Elm) 

Mucilago Ulmi 
Glycyrrhiza and its Preparations 
Poultices .... 



PAGE 

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A TEEATISE 



MATERIA MEDICA AND THERAPEUTICS. 



SCHEMA. 

Paet I. — Modes in which Medicines are introduced into the Or- 
ganism. 

Part II. — TJie Actions and Uses of Remedial Agents: 
Those used to promote constructive metamorphosis. 
Those used to promote destructive metamorphosis. 
Those used to prevent septic decomposition. 
Those used to modify the functions of the nervous system. 
Those used to cause some evacuation from the body. 
Part III. — Topical Remedies. 

In this scheme the action of the medicine is followed from its in- 
troduction into the stomach, to its exit through the organs of excretion. 
Some remedies are used solely or chiefly for their influence on the pri- 
mary assimilation ;. as, for example, pepsin, the simple bitters. Other 
remedies, with or without affecting the function of digestion, modify 
the process of assimilation, either promoting the construction of 
tissue, or the retrograde or destructive metamorphosis. Iron may be 
taken as a typical example of the one, and mercury of the other mode 
of action on the function of assimilation. The therapeutical applica- 
tion of these remedies is based in this conception of their physiologi- 
cal action. 

In the group of remedies used to prevent septic decomposition 
are included those having a destructive action on the minute organ- 
isms, or germs of disease. These agents have, also, distinct anti-py- 
retic effects, and a relation probably exists between the anti-ferment 
action and the power to reduce febrile heat. As substances having 
the reactions and toxic activity of alkaloids, and known as ptomaines, 



2 SCHEMA. 

are produced in the course of the putrefactive decomposition of the 
human body, and as alkaloids, closely related to those formed in the 
tissues of plants, are developed in the course of infectious diseases, 
there can be no doubt of the importance of this class of remedies. 
We are, however, yet in the infancy of our knowledge, but sufficient 
has been acquired to amply justify the construction of such a class of 
remedies. 

A large group of remedial agents is used not to influence the meta- 
morphosis of tissue, but simply to modify the functions of the nervous 
system, of which morphine and strychnine may be taken as types. It 
is true that probably no medicinal agent modifying function does so 
without affecting structure ; but, in the present state of our knowl- 
edge, we are, in respect to some of them at least, unable to designate 
the tissue-changes which they induce. 

To the class of evacuants belong emetics, cathartics, anthelmin- 
tics, and diuretics. These remedies are either so irritant as to excite 
speedy action for their expulsion, or they are eliminated by the 
organs on which they appear to have a selective effect. When the 
movement for their expulsion or elimination terminates, as a rule their 
action ceases. Some of these irritant emetics and cathartics, acting 
locally merely, might be classed with topical remedies, but such an 
arrangement would destroy the continuity of the subject. 

Topical remedies act upon the part to which they are applied. 
Absorption is not necessary to, and indeed hinders the local effect ; 
hence, any systemic impression produced by them is accomplished 
through the agency of the nervous system. Some of the most impor- 
tant of their therapeutical effects are due to the influence of the pe- 
ripheral excitation on the nervous centers in anatomical connection 
therewith. A superficial neuritis may excite extensive secondary 
lesions in the spinal cord. The vaso-motor and trophic systems are 
peculiarly impressionable to peripheric irritation, and hence, through 
the intermediation of this nervous apparatus, important changes may 
be wrought by slight counter-irritation. 



PART I. 

R UTES B Y WHICH MEDICINES ARE INTR OD TIC ED 
INTO THE ORGANISM. 



THROUGH THE EXTERNAL INTEGUMENT. 

By this tissue medicines are applied in the following modes : 

Enepidermatic. 

Epidermatic. 

Endermatic. 

Enepidermatic. — In this method, the medicament is placed in 
contact, only, with the epidermis, and friction, to hasten absorption, is 
not employed. Although the epidermis opposes a strong obstacle to 
absorption, it does not entirely prevent diffusion into the blood, as 
numerous facts show. The skin may be considered a colloidal sep- 
tum. The rate and degree of absorption of any medicine will depend, 
in large part, on its power of diffusion. Various circumstances influ- 
ence this — for example, the chemical position of the agent to be dif- 
fused. On one side of the colloidal septum — the skin — lie the blood- 
vessels, containing an alkaline fluid. An acid fluid on one side of the 
osmotic membrane, and an alkaline fluid on the other, are conditions 
most favorable to osmosis. Experiments are wanting on this point, 
but it is a reasonable presumption that solutions of medicinal sub- 
stances, acid in reaction, will find their way most readily into the 
blood. 

Besides the epidermis, the sebaceous matter of the skin offers more 
or less positive obstruction to cutaneous absorption. Medicinal sub- 
stances in solution in water, therefore, very slowly permeate the skin 
to enter the vessels. Waller, who has made very careful experiments, 
has ascertained that alkaloids dissolved in chloroform are readily trans- 
ferred through the skin into the blood, and produce characteristic phe- 
nomena, while " alcoholic and aqueous solutions are either not at all, or 
very slowly, absorbed." 



4 HOW MEDICINES ARE INTRODUCED. 

His observations were made with chlorof ormic solutions of aconi- 
tine, atropine, strychnine, and morphine. Waller further ascertained 
that alcohol mixed with chloroform did not retard absorption, but al- 
cohol alone caused an outward osmotic flow. It follows from these 
facts that, if, in the application of a medicinal agent to the skin by the 
endermatic method, the object be to promote absorption, the remedy 
should be dissolved in chloroform, or in a mixture of alcohol and chlo- 
roform, and not in alcohol alone, or in water. 

Epidermatic. — This method differs from the enepidermatic in that 
friction is employed to promote absorption by forcing the medicament 
between the cells of the epidermatic layer. Various agents are used 
in this way, as mercurial ointment in syphilis, cod-liver oil, and other 
fats, in wasting diseases, and ointments of various kinds for the relief 
of local lesions, etc. The evidence is conclusive that in this way sys- 
temic effects are produced. 

Endermatic.-*- As the epidermis is the chief obstacle to cutaneous 
absorption, it is sometimes removed by blistering, so that the medica- 
ment may come into immediate contact with the derma. The mode 
of proceeding by the endermatic method is as follows : a piece of flan- 
nel, patent lint, or cotton cloth, is moistened with aqua ammonice, and 
when placed on the skin is covered with oiled silk to prevent evapora- 
tion. When the blister is raised, the epidermis is removed with scis- 
sors. A less painful, but slower method, is the application of a can- 
tharides-plaster, followed by a poultice to raise the blister. The 
medicinal agent, in a finely-powdered state, is sprinkled over the raw 
surface, and is rapidly absorbed. Morphine, atropine, strychnine, and 
quinine, are the most important agents used in this way. 

The endermatic method is a useful resource to the therapeutist, 
but the opinion of Brown-Sequard is hardly admissible, that the exten- 
sive use of the hypodermatic method has caused the endermatic to be 
unwisely neglected. There are decided objections to the endermatic 
method : it is painful ; absorption is somewhat uncertain ; ulceration 
of an intractable character may occur. It has these advantages in its 
favor : it may be used in cases of irritable stomach ; it may be con- 
joined with counter-irritation ; it is sometimes quite effective. 

II. 

THROUGH THE INTERNAL INTEGUMENT. 

Applications to the Broncho-pulmonary Mucous Mem- 
brane. — By the method of insufflation solid medicinal agents in a 
finely-divided state are applied to various parts of the respiratory 
tract. Insufflation-tubes with a rubber air-bag attached are now 
found at the instrument-makers. The powder, contained in a chamber 
intended for its reception, is forced by the compression of the air-bag 



BY THE BRONCHO-PULMONARY MUCOUS MEMBRANE. 5 

through the straight or curved delivery-tube of the instrument. Pow- 
ders may be projected by such an apparatus into fauces, larynx, and 
anterior and posterior nares. In the absence of an insufflator, a sim- 
ple glass tube or goose-quill may be used for the purpose — the powder 
being blown in by the operator, or drawn in by a forcible inspiration 
by the patient. 

The method of insufflation is a useful mode of making local appli- 
cations to the nares, fauces, epiglottis, and the aryteno-epiglottidean 
folds, but it is of little utility as a means of reaching the larynx and 
trachea, for, as is well known, the glottis is exceedingly intolerant of 
foreign bodies whether solid or gaseous. By this method we can use 
tannin, the zinc salts, nitrate of silver, alum, morphine, etc. Any 
remedy thus applied should be in small quantity, should be minutely 
subdivided and mixed with some unirritating, impalpable powder, so 
as to insure uniform distribution over the surface to be acted upon. 

The nasal douche is a mode of applying remedies to the nasal pas- 
sages now much practiced. This consists of a bottle or funnel-shaped 
reservoir to contain the medicated fluid, and a flexible rubber tube to 
which is attached a hard-rubber or glass nose-piece. The reservoir be- 
ing placed on a higher level than the head, the nose-piece adjusted 
and the mouth being kept open, the fluid is permitted to flow. As when 
the mouth is open, the patient breathing quietly, the palate applies 
itself closely to the posterior wall of the pharynx, it is obvious that the 
fluid will be conducted from the one to the other nostril and thus make 
its exit. Not every patient can succeed perfectly in the performance 
of this feat. In some persons, even when breathing quietly through 
the open mouth, the veil of the palate does not apply itself perfectly 
to the posterior fauces and the fluid flows into the oesophagus. Other 
persons can not refrain from attempts at swallowing when the fluid 
reaches the posterior nares. In such instances the use of the nasal 
douche maybe attended with ill results. As has been shown by Moos, 
Roosa, and others, and as I have myself observed, the fluid may pass 
through the Eustachian tube into the middle ear, giving rise to destruc- 
tive inflammation and suppuration. If pain in the ears follows its use, 
it is quite certain that mischief will result if the douche be persisted 
in. The following rules should be adhered to in making applications 
by this method : 

The fluid used must be tepid. 

The first applications must be bland and unirritating. 

The applications, if strong enough to excite irritation, must not be 
used frequently. 

Under the most favorable circumstances this mode of treating dis- 
eases of the nasal passages has very limited utility, for the fluid reaches 
but a part of the Schneiderian mucous membrane. It is a useful means 
for cleansing the nares, and for applying deodorizing agents to correct 



6 HOW MEDICINES ARE INTRODUCED. 

fetor. Chlorides of sodium, potassium, and ammonium, permanganate 
of potassa, carbolic acid, iodine, and many other agents of the same 
kind, are applied by means of the nasal douche. 

An ordinary Davidson's syringe, made to act as a siphon, may be 
used in the same way as the Weber's or Thudichum's nasal douche. 
The mode of proceeding with this instrument is as follows : the vessel 
containing the medicated fluid is placed on a higher level than the 
patient's head ; the syringe is filled by compressing the bulb to expel 
the air, and then inserting the suction-pipe in the fluid ; the nozzle of 
the delivery-pipe is put into the nose, when a steady stream will dis- 
charge into the nostril and escape by the other. 

The method of inhalation is more generally applicable to the treat- 
ment of diseases of the broncho-pulmonary mucous membrane. Car- 
bolic acid, iodine in vapor, iodoform, sal-ammoniac, bromine, and other 
volatilizable solids and gases, may be readily and advantageously ap- 
plied in this way. A convenient mode of using iodine is the follow- 
ing : make a cone of stiff paper, so that the smaller extremity shall fit 
the mouth or nose, or both ; drop some tincture of iodine into a cup 
of hot water, so placed that the vapors will ascend through the funnel, 
the larger mouth of which is in position to intercept them. Iodoform 
vaporized on a warm plate or saucer may be similarly conducted into 
the mouth or nose. Some drops of bromine may be put into a warm 
vial, and the vapor be cautiously inhaled. Several forms of inhalers 
are now made for applying muriate of ammonia vapor, as it is formed 
by the combination of ammoniacal gas and the fumes of hydrochloric 
acid. 

The inhalation of carbolic acid alone or in combination with iodine, 
is especially useful in chronic bronchitis and phthisis. If the method 
of inhalation is pursued as above advised, the vapors pass into the 
lungs with the inspired air. The effect is very different when solu- 
tions of the medicaments are applied by means of pulverization or 
atomization of medicated fluids. Air or steam is the motive power in 
the various forms of apparatus used for reducing solutions of medici- 
nal agents into spray. Of those now in use, the hand-ball apparatus 
for air, and Siegle's apparatus for steam, are the principal. Whether 
air or steam be used for pulverizing the medicated fluid, the essential 
parts of an atomizing apparatus consist of a cup for containing the 
solution to be pulverized, a vertical tube terminating in a fine capillary 
extremity and dipping into the medicine-cup, and a tube communicat- 
ing with the steam-boiler or air-bulb, and placed at right angles to the 
vertical tube. When ail or steam is forced through the horizontal 
tube, over the capillary orifice of the vertical tube, the air in the latter 
is rarefied and the fluid rises into it, until, reaching the top of the tube, 
it is broken up into fine spray by the impact of the horizontal column 
of air. It is obvious that, provided with suitable tubes, spray may be 



BY THE GASTRO-INTESTINAL MUCOUS MEMBRANE. 7 

applied to the nares, anterior and posterior, to the pharynx, epiglottis, 
and larynx. The utility of applications made in this way to these 
parts is now conclusively established. Although it has been a ques- 
tion whether any quantity of medicated spray passes the chink of the 
glottis, it has been proved experimentally that a minute quantity does 
actually enter the trachea. The efficacy of inhalations of subsulphate 
of iron in pulmonary haemorrhage is a clinical fact confirmatory of the 
experimental demonstrations. The inhalations of substances in a state 
of vapor, and atomized, in affections of the parts beyond the larynx, 
have thus far been rather disappointing, except, it may be, the treat- 
ment of pulmonary haemorrhage by iron inhalations. 

In using the various inhalations, some precautions must be taken to 
avoid harm. Strong applications should not be made in the begin- 
ning of the treatment. The mucous membranes should be accustomed 
to the impact of such unirritating substances as warm water and tepid 
solutions of common salt and chloride of ammonium, before com- 
mencing the use of tannin, the zinc, copper, and silver salts, etc. For 
cleansing the mucous membrane and removing fetor, common salt, 
carbolic acid, iodine, and the sulphides are useful, and as astringents 
and deodorizers, the sulpho-carbolates of zinc, soda, etc. The most 
effective application for the cure of diseased states is nitrate of silver, 
but it should be kept in mind, in using this agent, that the handker- 
chiefs and linen of the patient will be soiled. Solutions of nitrate of 
silver are best applied by means of the hand-ball atomizer, tubes of 
various shapes, according to the locality, being inserted into the ante- 
rior and posterior nares, pharynx, or glottis, as the case may be. 
Should the steam atomizer be used for making application of the vari- 
ous salts named above, the face of the patient should be protected by 
a shield. 

Applications to the broncho-pulmonary mucous membrane are also 
made use of to procure absorption of the materials applied, and thus 
to produce systemic effects. Anodynes for the relief of cough, diffi- 
cult breathing, painful affections of the heart, etc., are applied to the 
fauces and larnyx by means of the steam atomizer. Various prepa- 
rations of opium, cannabis Indica, belladonna, and nitrite of amyl, are 
employed in this way. The most effective method of treating an asth- 
matic paroxysm is by means of a cigarette containing various narcotic 
substances. 

Application to the Gasteo-Ixtestinal Mucous Membeane. — 
The stomach is the organ most usually selected for procuring absorp- 
tion of remedial agents. Diffusion through the walls of the stomach 
into the blood is by no means definite in rate, or in the quantity passed 
even with the same medicament and in the same individual. The 
presence of fluid or food, the chemical reactions which may ensue, the 
state of the mucous membrane, the blood-pressure in the veins, and the 



8 HOW MEDICINES ARE INTRODUCED. 

condition of annexed organs, are circumstances modifying the rate and 
degree of absorption. The stomach empty, the mucous membrane in a 
healthy state, veins not turgid, are the conditions most favorable for 
rapid and perfect absorption. Crystalloidal substances in solution, 
which pass by simple osmosis into the vessels, are taken up more rap- 
idly and perfectly than colloidal substances which require preliminary 
digestion and solution. It follows, therefore, that medicines in solu- 
tions not intended for a merely local action on the stomach mucous 
membrane, and not irritant in character, as salines, alkaloids, etc., 
should be administered when the stomach is empty. Substances that 
are irritant, or that require digestion and solution, or that, like iron, are 
intended to supply a material to the blood in which it is deficient, are 
best administered during the process of digestion. On the other hand, 
many of the metallic salts precipitate pepsin and thus derange diges- 
tion, whence it follows that they should not be given after food, if un- 
impaired digestion be essential to the safety of the patient. 

Although it is true that medicines in solution are more readily 
taken up than solids, yet many of the latter are absorbed with great 
facility, as metallic iron, calomel, etc., which are rendered soluble by 
the gastric fluids. The chemical changes induced in medicines by the 
gastric juice are by no means well understood. How individual 
agents are affected is a subject to be considered hereafter. 

The following are the chief forms in which medicines are adminis- 
tered by the stomach : 

Powders are medicines reduced by mechanical subdivision, or by 
precipitation, to various degrees of fineness. The Pharmacopoeia of 
1880 advises several grades ; a very fine powder is one triturated to 
that degree that it should pass through a sieve having eighty or more 
meshes to the linear inch ; a fine powder is one which should pass 
through a sieve having sixty meshes to the linear inch ; a moderately 
fine powder is one which should pass through fifty meshes ; a moder- 
ately coarse powder through one having forty meshes, and a coarse 
powder through one having twenty meshes to the linear inch. These 
powders are designated respectively No. 80, No. 60, No. 50, No. 40 and 
No. 20. Those soluble in water are usually administered in that men- 
struum. If insoluble, they may be suspended in water by means of 
sugar, sirup, solution of gum, glycerin, or they may be rubbed up 
with some innocuous powder, as sugar, sugar of milk, liquorice-pow- 
der, etc. 

Pills are small masses of medicine made into a globular shape, 
by means of an extract, conserve of roses, sirup, or glycerin. A pill 
should not exceed five grains in weight, including the excipient, and, 
as a rule, it should be smaller than this. To cover the taste, pills may 
be coated with sugar, gum, gelatin, silver or gold foil. It should not 
be overlooked that pills too long kept, especially when sugar-coated, be- 



* BY THE GASTRO-INTESTIKA.L MUCOUS MEMBRANE. 9 

come very hard and insoluble, and therefore without activity. Extem- 
poraneously, pills may be covered with fine tissue-paper, or enveloped 
in a raisin, to cover the taste of the ingredients. 

A Mixture is a suspension of one or more insoluble substances in 
the vehicle, by means of sugar, gum, glycerin, treacle, albumen, etc. 
The term emulsion is restricted in application to the mixture of oil 
and water, in which the oily particles are suspended mechanically by 
rubbing them up with water and gum. 

Extracts are solid and fluid. The solid extract may be aqueous 
or alcoholic ; in the one case water, in the other alcohol, being the 
menstruum employed to extract the active and soluble principles. An 
extract is solid when evaporation is carried far enough to produce a 
soft paste or a dry mass ; it is fluid when sufficient alcohol and water 
are retained to give the proper fluidity. The strength of the fluid 
extract (Pharmacopoeia, 1880) is as follows : " One hundred avoirdu- 
pois ounces of drug make ninety-six fluid ounces," or nearly one minim 
to one grain. The strength of the fluid extract prepared according 
to the Pharmacopoeia of 1870 is five per cent greater. 

Abstracta are dry, powdered extracts, having about twice the 
strength of the official fluid extract. The mode of preparation is as 
follows : An alcoholic tincture is first prepared, the alcohol is then 
evaporated, and the residue is thoroughly triturated with sugar of 
milk. 

Infusions are such solutions of active and soluble principles as can 
be extracted by digesting the crude drug in water, cold or at a tem- 
perature short of boiling. When water at the boiling temperature is 
used, the resulting solution is termed a decoction. Cold infusions are, 
when practicable, to be preferred to decoctions, for, at the tempera- 
ture of boiling water, many active principles are decomposed or vola- 
tilized. 

Infusa are prepared by taking 10 parts of the drug coarsely com- 
minuted, and 100 parts of boiling water, which is poured on ; allowed 
to stand for two hours in a suitable covered vessel, and is then strained, 
and sufficient cold water is added to make 100 parts. 

Decocta are prepared of the same strength as infusions — 10 parts 
to 100 — but the medicament, coarsely powdered, is put into 100 parts 
of cold water, and boiled for fifteen minutes. It is then allowed to 
cool to 113° Fahr., when sufficient cold water is added to make 100 
parts. 

Aceta consist of 10 parts of drug to 100 parts of diluted acetic 
acid. Acidum aceticum dilutum consists of 17 parts of acid and 83 
parts of water, and therefore contains six per cent of absolute acetic acid. 

Vina are preparations made with vinum album fortius, but differ 
in strength. The official vinum album fortius is prepared by adding 1 
part of alcohol to 7 parts of white wine. 



10 HOW MEDICINES ARE INTRODUCED. 

Triturationes are made by triturating 10 parts of the drug with 
90 parts of sugar of milk. 

Capsules are hollow cylinders or cones of gelatin, to contain offen- 
sively-tasting substances, as copaiba, oil of sandal-wood, etc. In the 
stomach the gelatin is dissolved and the medicament liberated. 

Lozenges or Troches, button-shaped masses, are sometimes intro- 
duced into the stomach, but usually these bodies are intended to 
be dissolved slowly in the mouth, to exert a local action on the 
fauces. 

Wafers are circular disks with a central cavity for holding the 
medicine. They are made of isinglass. 

A Suppository is a conical mass of cacao-butter, or wax and cacao- 
butter, with which is incorporated a medicament, and should not weigh 
more than fifteen grains. They are applied to the rectum, vagina, 
and urethra. 

Clyster, Enema, Lavement, are medicated solutions to be thrown 
into the rectum. 

Although the rectum as an absorbing surface is inferior to the stom- 
ach, medicines are frequently introduced by this organ with great ad- 
vantage. Some medicines enter the blood more quickly by the rectum 
than by the stomach, but, as a general rule, absorption is slower by the 
former organ. If the mucous membrane of the rectum be irritable, or 
if the substances introduced be irritating or bulky, they will not be re- 
tained. As the contents of the rectum are alkaline, solids requiring an 
acid for their solution will not be taken up. Acid solutions of medici- 
nal agents, on the other hand, are readily enough absorbed, provided 
the quantity of acid present be sufficient to maintain solution. As a 
general rule the mineral salts act chiefly locally on the mucous mem- 
brane of the rectum and enter the blood in small quantity. The salts 
of the alkaloids, on the other hand, are absorbed with facility. Alka- 
loids insoluble unless in presence of an acid are not absorbed with the 
same rapidity and completeness by the rectum as by the stomach, unless 
they are administered in acid solution. The salts of morphine, atro- 
pine, and strychnine, in solution, are absorbed as quickly, and the last 
named more quickly by the rectum than by the stomach. 

Remedies administered by the rectum maybe in solution suspended 
in some menstruum, or incorporated with a soap or fat in the form of 
suppository. The solution used should have the temperature of the 
rectum (about 100° Fahr.). The quantity administered should not ex- 
ceed two fluid-ounces of solution. Before introducing a medicated 
solution or clyster into the rectum, this organ should be emptied of 
fecal matter by an ordinary enema. 

Administration of remedies by the rectum is an important resource 
to the therapeutist in cases of inability to swallow, irritable stomach, 
and in children's maladies. Unfortunately, this organ soon becomes 



BY THE SUBCUTANEOUS AREOLAR TISSUE. 11 

intolerant, the mucous membrane irritable, and the medicament is 
either at once rejected or absorption delayed. 

Applications to the Gexito-TTrinaey Mucous Membrane. — 
Brown-Sequard has proposed to utilize the bladder for securing absorp- 
tion of remedial agents in cases of great intestinal disorder, as in 
cholera. Experiment has shown that morphine, for example, is taken 
np with considerable rapidity by this viscus. 

Topical applications to the urethra and vagina are very frequently 
made, usually in the form of astringent injections. Suppositories, vari- 
ously medicated, are also occasionally used in the treatment of affec- 
tions of these parts. 

III. 

BY THE SUBCUTANEOUS AREOLAR TISSUE— THE HYPODERMATIC OR 
HYPODERMIC METHOD. 

The term hypodermatic is used in conformity with the nomencla- 
ture already existing — as " epidermic," " endermic," etc. — but the ter- 
mination of the word is now altered in deference to the opinions of 
the best philologists. The term hypodermic, which has been univer- 
sally adopted, is known to be formed on wrong principles, and hence, 
in accordance with the rules of construction, the word hypodermatic 
is substituted. As the term indicates, by this method the medicine is 
applied to the subcutaneous areolar tissue. This does not include the 
method of "inoculation," introduced by Laf argue, nor that proposed 
by Luton and Bertin, which consists in the injection of irritants into 
diseased tissues. It is obvious that by the hypodermatic method 
medicines can be introduced only in the state of solution. To intro- 
duce the solution under the skin, a special instrument is necessary. 
This is the now well-known hypodermatic syringe — a small syringe 
having a capacity not to exceed a drachm — the nozzle being a hollow 
needle having a lancet-shaped extremity for easily transfixing the skin. 
These instruments are various in form and construction, and are made 
of gold, silver, glass, or hard rubber. The most efficient instrument 
for ordinary use is the silver hypodermatic syringe described by the 
author. The piston-rod of this instrument should be semi-cylindrical 
and should be graduated for minims on its flat side, to indicate the 
quantity of solution contained in the barrel. Glass hypodermatic syr- 
inges break easily, and the mountings work loose and give way. Now, 
however, the glass cylinder is in part inclosed in a metal sheath, for 
greater strength and security. A graduated hypodermatic syringe 
should not be used until the exact value of the divisions of the 
scale has been determined by comparison with a standard minim- 
glass. 

A medicine employed for hypodermatic use should be capable of 



12 HOW MEDICINES ARE INTRODUCED. 

perfect solution in the menstruum, which is usually distilled or pure 
water. Particles of medicine undissolved are not only not in a pondi- 
tion for ready absorption, but are irritant to the tissues, producing in- 
flammation and abscess. The solution for hypodermatic use should be 
free from foreign matter of every description and should be neutral in 
reaction, or, at least, without decided acid or alkaline property. Any 
substance which will coagulate the blood or produce violent local irri- 
tation is unfit for hypodermatic use. A solution of even a neutral 
substance should not be too concentrated. Clean water, free from 
visible impurities, is entirely harmless, and the quantity of fluid injected 
is, within certain limits, a matter of indifference, provided suitable 
care be used in selecting the site and injecting. On the other hand, 
concentrated solutions are more apt to produce local irritation than 
dilute solutions. Moreover, a drop too much of a concentrated solu- 
tion of a powerful alkaloid may produce an alarming, if not danger- 
ous state. In ordinary syringes a few drops remain at the bottom of 
the barrel and in the needle — whence it follows, in using strong solu- 
tions, it is difficult to inject the precise amount desired. 

Solutions of alkaloids, too long kept, become unfit for use, hypoder- 
matically, by reason of the development in them of a penicillium, a 
minute organism which grows at the expense of the alkaloid. Fresh 
solutions should be made when needed. When hypodermatic injec- 
tions are used infrequently, it is preferable to prepare an extempore 
solution, using powders of a definite strength. Filtered river, melted 
ice, or rain water, may be used for dissolving the powders. Solutions 
prepared extemporaneously from ordinary spring or rain water are 
found to produce less inflammation, and are less likely to be followed 
by abscess, than solutions prepared with pure distilled water which 
have been kept for several days. The author, therefore, advises the 
use of extemporaneous solutions, powders of suitable strength being 
kept for the purpose. 

In practicing the hypodermatic injection it is important to avoid 
puncturing a vein. Serious depression of the powers of life and sudden 
and profound narcotism have been produced by injecting a solution of 
morphine directly into a vein. Fatal collapse may ensue from injecting 
air into a vein along with the narcotic solution. Bony prominences 
ought to be avoided, and also inflamed parts. It is not necessary to 
follow Wood, the discoverer of the hypodermatic method, who advised 
that the solution be inserted at those points where pain can be 
awakened by pressure (the painful points of Valleix). Some excep- 
tions to this rule undoubtedly exist. The arms, the abdomen, the 
thighs, the calves of the legs, and the back, are suitable places. Eulen- 
burg makes the assertion that the effect is slower when the injection 
is made in the back, but I have not observed this difference. 



BY THE SUBCUTANEOUS AREOLAR TISSUE. 13 

THE FOLLOWING ARE THE REMEDIES, SOLUTIONS, AND DOSES, EMPLOYED 
BY THE HYPODERMATIC METHOD: 

Moephina — Morphine. I£ Morphinse sulphat., gr. xvj ; aquae, § j. M. Sig. : 
Two (2) minims are equal to one fifteenth of a grain. 

An antiseptic solution of morphia, intended to be kept for several weeks, may 
be prepared according to the following formula: 

3 Morphinse sulph., gr. xvj; acid, carbolic, gtt. v; aquae, fj. M. Sig.: 
Two minims contain T V of a grain of sulphate of morphia. 

Solutions of morphine may be readily prepared extemporaneously from pow- 
ders of a definite strength, as follows: 

5 Morphinse sulphat., Bj ; atropinse sulphat., gr. ss. M. Ft. pulv. No. cxx 
(120). Sig. : Each powder contains \ of a grain of morphine and ^-^ grain of 
atropine. 

Powders of morphine containing the necessary quantity may also be used 
extemporaneously, dissolved in sufficient water. It is now known that a solu- 
tion thus prepared is less likely to produce local irritation and induration than 
a prepared solution kept some days before using it. The chief cause of the irri- 
tating qualities of such a solution is the development of a penicillium — a minute 
organism, which grows in an alkaloidal solution, at the expense of the alkaloid. 
The author, therefore, advises the habitual use of powders of suitable strength 
made into extemporaneous solutions whenever practicable, rather than the per- 
manent solutions. 

There are now prepared for physicians' use, gelatin disks containing certain 
defined proportions of the alkaloids, and also " hypodermic tablets," so called, 
having a definite measure of morphine, or combined morphine and atropine, and 
morphine and other alkaloids. These preparations are useful, but the author is 
convinced, after considerable experience, that no substitute hitherto proposed 
will prove as satisfactory in all respects as the extemporaneous solution of the 
alkaloids. Experience has shown that fresh water, whether cistern (rain) or 
hydrant (river) water, is preferable to distilled water. Hence, a powder of mor- 
phine, dissolved at the moment it is required, in ordinary clean water, is safer in 
respect to local complications than the most carefully prepared solution in dis- 
tilled water. 

Ateopina — Atropine. IJ Atropines sulphat., gr. ij; aquse, §j. M. Sig.: 
One minim contains -^to of a grain. Three (3) minims contain ^ of a grain, 
which is a maximum dose for many persons. 

Moephina and Ateopina. — 1$ Morphinse sulphat., gr. xvj ; atropinse sul- 
phat., gr. ss. ; aquse, § j. M. Sig. : Six (6) minims contain ^ grain of morphine 
and T ^ grain of atropine. 

Powders prepared in conformity to this formula may be dissolved when re- 
quired. " Hypodermic tablets " are also made in the same strength. A good 
formula for the powders is the following : 

5 Morphinse sulphat., 3j ; atropinse sulphat., gr. ss. M. Ft. pulv. No. cxx 
(120). Sig. : Each powder contains | of a grain of morphine and -^ of a grain 
of atropine. 

Dtjboisixa — Duboisine. I£ Duboisinse sulphat., gr. j ; aquae, § j. M. Sig. : 
Four (4) minims contain T ^ of a grain. Eight minims is the usual maximum 
dose for an adult. 

Hyosoyamina — Hyoscy amine. IJ Hyoscyaminse, gr. j ; acid, sulphuric, dil., 
TTl v: aquse, |j. M. Sig.: Five (5) minims contain -£-$ grain. 



14 HOW MEDICINES ARE INTRODUCED. 

Hyoscyamine may be dissolved in water and glycerin, as follows : 

3 Hyoscyaminae (cryst.), gr. ij ; glycerini, aquae, aa TTJ, c (100 minims). 
M. Sig. : Each, minim contains ^-g- of a grain. 

Steychnina — Strychnine. B Strychninaa sulphat., gr. j ; aquae, ^j. M. 
Sig. : Ten (10) minims contain ^ of a grain. 

Conesta, Coniine. 3 Coninae hydrobromat., gr. j ; aquae, § j. M. Sig. : 
Ten (10) minims contain ^ of a grain. 

The hydriodate and the tartrate are also now made, and can be used in the 
same strength. 

Cueaea— or Woorara. 3 Curarae, gr. j ; acid, acetic, HI v; aquae, ad m c 
(to 100 minims). M. Filter. Sig. : Ten (10) minims contain yV of a grain. 

As the active constituents of curara are soluble in water, an aqueous solution 
will contain them — the residue being woody fiber, starch-granules, etc. As, 
however, the specimens vary greatly in strength, the character of any new 
specimen should be ascertained by trial on animals before giving it to man. 

Any salt of the alkaloid, curarine, will, however, be more exact in its effects. 

3 Curarinae sulphat., gr. j ; aquae, f ss. M. Sig. : Four (4) minims con- 
tain -fa of a grain. 

Tabacum — Tobacco. Nicotiana — Nicotine. IJ Nicotianae, tt[ j ; acid, acetic, 
i^v; aquae, 3 iv. M. Sig.: Four (4) minims contain -fa of a grain. 

Acidtjm Hydeocyanicum Dilutum. 3 Acid, hydrocyanic, dil., q. s. Sig. : 
Four minims is the maximum single dose. 

Physostigma — Calabar-Bean. Eseeina, Eserine. The extract of Calabar- 
bean dissolved in sufficient water, and filtered, is used hypodermatically, some- 
times ; but the alkaloid eserine is to be preferred. 

3 Eserinae sulph. vel muriat., gr. j ; aquae, 3 iv. M. Sig. : Four (4) min- 
ims contain -fa of a grain. 

Pilocaepina — Pilocarpine. 3 Pilocarpine nitrat., gr. xvj ; aquae, |j. 
M. Sig. : Five (5) minims contain (|) one sixth of a grain. 

Amyli Niteittjm — Nitrite of Amyl. From three (3) to five (5) minims of 
amyl nitrite can be injected subcutaneously at a time. The repetition of the 
dose will depend on the effect, but the injection may be practiced every half- 
hour for a time. 

Chloeofoemum Ptteifioatitm — Purified Chloroform. From five (5) to fifteen 
(15) minims can be used at one injection. This agent is employed by the "deep 
method " — i. e., the chloroform is thrown by the syringe deeply and in the neigh- 
borhood of the nerve-trunk, the seat of pain. 

The official spiritus chloroformi has also been used successfully in the same 
group of cases. 

Alcohol and Ethee are also injected subcutaneously — alcohol in the diluted 
form, as whisky or brandy, and pure ether. 

Chloeal Hydeate. 3 Chloral, hydrat., § ss. ; aquae, | j. M. Sig. : Thirty 
(30) minims contain fifteen (15) grains of chloral. 

Sometimes it is advantageous to give chloral and morphine together. 

Caffefna — Caffeine. 3 Caffeines citratis, gr. xxiv; aquae, f j. M. Sig.: 
Twenty minims contain one grain. 

Apomoephina — Apomorphine. 1$ Apomorphinae, gr. j. Ft. pulv. No. xvi. 
Sig. : One or more may be dissolved in sufficient water as required. 

Apomorphine undergoes a change in the presence of moisture, especially 
when kept in solution for some time ; hence the solution for hypodermatic in- 



BY THE SUBCUTANEOUS AREOLAR TISSUE. 15 

jection should be prepared when required. The dose ranges from T ^ of a grain 
to £ of a grain. 

Eegota — Ergot. I£ Ext. ergotae, 3j; aqua?, |j. M. Sig. : Twenty min- 
ims contain two (2) grains. 

Quinlsa — Quinine. " ^ Quininaa disulphat., gr. 1 (50) ; acid, sulphuric, 
dil., "HI c (100); aquae font. |j; acid, carbolic, liq., v\ v (5). Solve. 

u Place the quinine and water in a porcelain dish over a spirit-lamp ; heat to 
the boiling-point, and add the sulphuric acid, stirring with a wooden spatula. 
Filter at once into a bottle, and add the carbolic acid. This gives six grains to 
the drachm." 

The above is the formula of Dr. Lente as given by himself. All solutions 
containing sulphuric acid are very irritating. Hence, those which can be pre- 
pared without acid are much to be preferred. The hydrobromate of quinia is 
soluble in a degree sufficient for hypodermatic use : thus, 

1$ Quininae hydrobromat., gr. xlviii ; aquae destil., 3 iv. M. Dissolve, and 
by heat if necessary. Sig. : Twenty (20) minims contain 4 grains. 

Quinina bimuriatica carbamidata, a combination of quinine and urea, is 
freely soluble — in equal parts of water, in fact — and therefore a most useful 
preparation for hypodermatic use. 

Acidum Caebolicum — Carbolic Acid. I£ Acid, carbolic, purif., gr. x ; aquas, 
§j. M. Sig.: Eight minims contain ^ of a grain. 

The quantity administered will range from one sixth of a grain to two or 
three grains. 

Hydbaegyettm — Mercury. The solutions of mercury now chiefly used are 
those of the corrosive chloride and the albuminate. Formulas for both are sub- 
joined : 

^ Hydrarg. chlor. cor., gr. j; aquaa, fj. M. Sig.: Ten (10) minims con- 
tain J F of a grain. 

Various albuminous solutions of mercury have been proposed: the chlorides 
of mercury, ammonium, and sodium, mixed with albumen. 

Aesexicum — Arsenic. The preparations of arsenic used hypodermatically are 
Fowler's and Pearson's solutions; the former in doses from two (2) to ten (10) 
drops, and the latter in twice the quantity. 

Aquapttnctitbe. — By aquapuncture is meant the injection of pure water 
beneath the skin. A special instrument has been invented to effect this ; but 
ordinarily a hypodermatic syringe will suffice for this purpose. From a half- 
drachm to a drachm is thrown under the skin over the organ or part on which 
it is intended to act. 

Iebitaxt Injections. — Injections intended to excite local inflammation are 
also employed in various morbid states. The materials so used, and the condi- 
tions requiring them, will be set forth hereafter. 



IV. 

BY THE VEINS. 

The injection into the veins of medicinal agents is too dangerous a 
procedure to be lightly undertaken, and is admissible only in emergen- 
cies. Formerly, before the introduction of the hypodermatic method, 
the injection of medicines directly into the blood was suggested and 



16 HOW MEDICINES ARE INTRODUCED. 

occasionally practiced in cases of asphyxia, in the collapse of cholera, 
in the insensibility due to narcotic poisons, etc. At present this 
method is restricted within narrower limits. Some remarkable results 
have been obtained by the injection of a saline solution in the veins in 
cases of the collapse of cholera. Unfortunately, the appearances of 
improvement, which are very remarkable, are not usually sustained, 
although Little reports five recoveries out of twenty apparently hope- 
less cases treated in this way. Dr. Hilton Fagge has recently reported 
a case of diabetic coma, in which the injection of twenty-six ounces of 
a warm solution of salines (phosphate and chloride of soda) produced 
an astonishing improvement in the condition of the patient. A suit- 
able saline solution for intra-venous injection may be made of phos- 
phate, carbonate, and chloride of sodium, dissolved in water at the 
temperature of 100° Fahr. until the specific gravity of 1020 is attained. 
The instruments employed for transfusion of blood may be used for 
the intra-venous injection of salines, especially the apparatus of Dr. 
Aveling for immediate transfusion, or the aspirateur modified accord- 
ing to the plan of Dr. Howe, of New York, when used for transfusion 
mediate or immediate. In the absence of these, an ordinary David- 
son's syringe may be used for this purpose by attaching to it suitable 
canulse. 

Halford, of Australia, has recently practiced the injection of am- 
monia into the veins, in the treatment of the bite of venomous snakes. 
He employs one part of the stronger aqua ammonice to two parts of 
distilled water, the injection being made with an ordinary hypodermat- 
ic syringe. A vein in a convenient situation is selected, the needle is 
inserted into it, and the solution of ammonia is thrown in gradually. 
The operation may be repeated, as necessary, the guide to the repetition 
of the injection being the state of the circulation. Fayrer shows that 
this practice is not successful in the systemic condition caused by the 
bite of the venomous snakes of India, and the special committee of the 
Medical Society of Victoria, appointed to investigate the subject of 
the intra-venous injection of ammonia, report adversely to the claims 
of Halford. The proposer of this expedient has, at least, demonstrated 
the safety of the intra-venous injection of ammonia ; and, although 
his first claim has been shown to be incorrect, the method itself has 
been utilized in other maladies : for example, in chloroform asphyxia, 
opium narcosis, hydrocyanic-acid poisoning, etc. It has been used, 
not with encouraging success, however, in septic states with a tend- 
ency to the coagulation of the blood in the larger venous trunks. Fail- 
ure of the heart's action and thrombosis of the pidmonary artery, post 
partum, are also indications for the intra-venous injection of ammonia. 

Transfusion. — This consists in an operation for substituting healthy 
blood for the abnormal fluid occurring in certain diseases, and for sup- 
plying blood in cases in which a deficiency exists by reason of hsemor- 



TRANSFUSION. 17 

rhage. Ordinarily the blood of a healthy adult is used in transfusion, 
because ever since the time of Blundell it was supposed the blood of 
an animal would not functionate properly in the arterial system. This 
notion is now, however, fully exploded, and Gesellius has especially 
shown, in his elaborate monograph on transfusion, that lamb's blood 
will answer the same purpose in the human system as human blood. 

As the red globule is the vivifying constituent of the blood, and as 
the fibrin is non-essential to the most important office, at least of the 
circulating fluid, it is obvious that defibrinated blood may be used for 
transfusion. According to the statistics collected by Gesellius, of one 
hundred and forty-six cases of transfusion with blood without defibri- 
nation, seventy-nine, or 54*11 per cent, were successful, and, of one 
hundred and fifteen cases in which defibrinated blood was used, sev- 
enty-nine, or 68-70 per cent, proved fatal. Mr. Higginson, of Liver- 
pool, reports thirteen cases occurring under his own observation, in 
which mediate transfusion with pure blood was employed, with the 
result of six successful. The injection of defibrinated blood is free 
from one source of danger — the introduction of clots into the circula- 
tion — which, as Panum has shown, will be followed by the disastrous 
result of multiple embolisms, or thrombus of the pulmonary artery. 
Separating the fibrin, however, renders the blood much less capable of 
performing its office. The necessary agitation in order to coagulate 
the fibrin injures the blood-globules, and the fibrin itself is necessary 
to prevent transudations and the recurrence of haemorrhage. With 
the improved instruments now used for the operation, and with the 
exercise of the necessary care, there need be no formation of clots, the 
chief danger in the use of blood containing its fibrin. 

Transfusion may be mediate or immediate. Mediate transfusion 
consists in the reception of the blood in a suitable vessel, and its trans- 
ference by means of an injecting apparatus into the veins of the pa- 
tient. Immediate transfusion consists in an apparatus for making di- 
rect communication, from the vein of the person or animal furnishing 
the blood, with the vein of the patient receiving it. A number of ap- 
pliances have been invented for mediate transfusion. Martin, of Ber- 
lin, has used in his operations a glass syringe provided with a suitable 
canula for insertion into the vein. Belina invented an apparatus con- 
sisting of a receiver for the blood, a hand-ball like that of the spray- 
douche, and a flexible tube provided with a stop-cock and canula. Beli- 
na, who has treated at great length of the operative procedure, decides 
that all forms of syringes are objectionable. Higginson proposed and 
has used successfully an instrument similar to the enema-syringe in- 
vented by him. This apparatus can, however, only be used for mediate 
transfusion. As immediate transfusion is to be preferred, as a rule, it 
were better to be provided with a suitable instrument for this opera- 
tion. The instrument invented by Dr. Aveling, and presented to the 
2 



18 HOW MEDICINES ARE INTRODUCED. 

Obstetrical Society of London in 1864, is at the same time the simplest 
and most effective. This consists of a hand-ball and flexible tubes 
like a Davidson syringe, but without valves. There are two canulae 
attached to either extremity of the flexible tubes — one for insertion 
into the vein furnishing the blood, and the other for insertion into the 
vein receiving it. The small-sized Davidson syringe will answer per- 
fectly well by removing the valves, the action of which tends to sepa- 
rate the fibrin, and fitting to the flexible tubes suitable perforated nee- 
dles or canulae. In using Aveling's instrument it must be first put into 
water at the temperature of 100° Fahr., and it must be filled with warm 
water, or better, a warm solution of phosphate and chloride of sodium 
of a specific gravity of 1020. The object of this is to exclude the air 
from the apparatus. The next step consists in inserting the canula in a 
vein — usually of the forearm — of the person or animal furnishing the 
blood, and in a position so that the blood-current will be in the direc- 
tion of the current in the patient receiving it. Should the veins of the 
patient be collapsed, the skin overlying those at the elbow may be 
transfixed and raised, which will bring into view a vein into which the 
canula may be inserted — care being used here that the direction of the 
current shall be toward the heart. The canulae can be held in position 
by the fingers of assistants. The operator compresses the bulb gently, 
pressing at the same time the supply-tube between the thumb and fin- 
ger of the other hand, in order to prevent a reflux of the fluid. When 
the bulb is emptied, the delivery-tube is pressed between the thumb 
and finger shifted from the supply-tube, and the bulb is allowed to fill 
with blood from the source of supply. In this way, successive charges 
of fresh blood can be delivered without difficulty into the patient's 
vein. The aspirateur may be used in the same way for immediate 
transfusion, as has been suggested by Dr. J. W. Howe, of New York, 
who has used it successfully. He advises the substitution of smaller 
tubes than those which accompany this instrument, and he has devised 
suitable canulae for the veins. 

The quantity of blood which it is advisable to introduce varies 
from four to eight ounces. The smaller amount is generally more suc- 
cessful. Too large an amount will seriously embarrass the heart. A 
further precaution is necessary as to the manner of injection ; force 
is never necessary, and may be very injurious ; the blood should be de- 
livered into the vein slowly and gently. 

Besides the danger arising from coagulation of the blood and the 
formation of thrombi, immediate bad symptoms or fatal syncope may 
come on from the introduction of air into the veins. The utmost care 
is necessary to exclude air from the apparatus. Phlebitis may also 
ensue from the injury done to the vein, and the patient's life be put in 
jeopardy from this cause, but this is a danger much more remote than 
the introduction of air and clots into the circulation. 



TRANSFUSION. 19 

As a number of successful cases of transfusion (Gesellius, Hasse, 
and others) have been reported in which lamb's blood was used, the 
practitioner is now justified in its employment, notwithstanding Landois 
has shown by experiment that transfusion of mixed blood does injury 
to the red blood-globules. If lamb's blood is to be used, the animal 
should be sufficiently anaesthetized to keep it quiet, and it should be 
securely tied. A vein may be selected, and immediate transfusion 
performed with Aveling's instrument or with the aspirateur in the 
mode already described. 

Transfusion is especially indicated in cases in which life is put in 
imminent jeopardy by haemorrhage. According to Belina, it is in 
haemorrhage from abortion, and during the first months of pregnancy, 
that transfusion is most successful. Of thirteen cases of haemorrhage 
from abortion thus treated, according to this author, eleven had a 
fortunate issue. Of the cases of post-partum hemorrhage — eighty -five 
in number — in which this expedient was adopted, fifty-six resulted 
favorably. Routh, Soden, Hicks, McDonnell, Mudge, Howe, and 
others, have reported successful cases, not included in the statistics of 
Belina. In other forms of haemorrhage, hoematemesis, intestinal haem- 
orrhage, epistaxis, etc., in which death by exhaustion is imminent, the 
operation of transfusion is proper. Belina has collected twenty-six 
cases of traumatic haemorrhage, of which twelve resulted favorably, 
in two the result was doubtful, and twelve terminated fatally. 

Transfusion has also been employed in certain morbid states of the 
blood, but not with encouraging results. Thus, Belina has collected 
a number of cases belonging to this category, of which nineteen termi- 
nated favorably, in two the result was equivocal, in three temporarily 
beneficial, and thirty-nine died. Two very interesting cases of the 
hcemorrhagie diathesis successfully treated by transfusion have been 
reported by Dr. Joseph Buchser, of New York. This form of consti- 
tutional cachexia is especially an indication for transfusion. In the 
treatment of anaemia this operation has not been successful. Thus, 
three cases treated by Stohr, of Wiirzburg, terminated fatally. Cases 
have also been reported by Concato, Cavaleri, and others. Transfusion 
has been used very successfully in cases of carbonic-oxide poisoning 
(Uterhart, Prof. Konig, Prof. Martin), and in phosphorus-poisoning 
(Prof. Jurgensen). 

Eulenburg and Landois advise transfusion in cases of danger to life 
from poisons for which there are no antidotes. It has been recom- 
mended, in such cases, to abstract blood and to suppy fresh blood to 
the suffering organism. Nussbaum has employed transfusion with 
complete success in epilepsy, and it has also been used with favorable 
results in eclampsia due to uremic poisoning. 

Arterial Transfusion. — Prof. Albanese has proposed injection of 
defibrinated blood into an artery, either the radial or posterior tibi- 



20 HOW MEDICINES ARE INTRODUCED. 

al, as a substitute for the intra- venous injection. The artery is ex- 
posed, punctured, and the blood thrown into it, in the same way as 
in the operation on the vein. It is claimed for this method that 
thrombosis is less apt to occur, and that the danger arising from the 
introduction of air is obviated. When a large amount of blood is 
necessary, it is more safely introduced by the arterial system, because, 
having to traverse the capillaries before reaching the right side of 
the heart, sudden distention of this organ is avoided. Prof. Htiter, 
who has especially advocated this method, reports a number of cases 
successfully performed in this way, and Asche has collected a number 
of others. 

Transfusion of Milk. — The experiments of Donne on animals 
demonstrated the harmlessness of the intra- venous injection of milk. 
Hodder, of Canada, was the first to employ this expedient on man ; 
and, of three cases of cholera collapse which he thus treated, two re- 
covered. Thomas, of New York, has also transfused milk with success 
in postpartum haemorrhage ; and Wagstaff has failed twice with the 
same method in traumatic hemorrhage. Within the present year 
(1880) Mr. Arthur Meldon has published an account of three cases in 
which the transfusion of milk was performed with success. 

When milk is used for transfusion, it should be fresh and directly 
from the cow if practicable, and its temperature should be that of the 
blood itself — 100° Fahr. Not more than four to six ounces should be 
injected at one time, lest the heart be paralyzed by over-distention. 
The effects which follow the intra-venous injection of milk are very 
much the same as those produced by blood, except that they are prob- 
ably less permanent, and that albuminuria is a frequent result. That 
this expedient is as useful as blood transfusion by the immediate 
method has been strongly maintained, but the most recent experience 
does not justify this opinion. Indeed, it is probable that the chief 
value of blood transfusion, in functional diseases, is to gain time for 
the operation of other and more permanent measures (Pepper). We 
also agree in the estimate of Dr. Pepper that transfusion in any of its 
forms is without utility in important organic diseases. 

In an experimental inquiry into the methods of transfusion, Schafer 
has examined anew the question of the substitution of some other fluid 
for blood, deciding with Landois, of Germany, and Howe and Dupuy, 
of America, that the introduction of any other fluid does injury to the 
corpuscles, and that a fluid without haemoglobin can not functionate 
as blood. As respects the substitution of the blood of some other 
animal — lamb's blood, for example — the conclusion of Schafer is in 
accord with the previously expressed judgment of Landois, that only 
human blood should be used in transfusion on man. Schafer has also 
made some important observations on the best mode of performing 
the operation. He finds that the best results are obtained on animals 



TRANSFUSION. 21 

by arterial transfusion, and recommends that the dorsal artery of the 
foot be used for receiving and furnishing the blood in the operation 
on man. When the artery is used the blood is received into that part 
of the vascular system where it is most needed, and only an elastic 
rubber tube and glass canula are required, the force of the donor's cir- 
culation being sufficient to propel the blood. There is no danger of 
the supply from the donor becoming excessive, as the pressure in the 
arterial systems of the donor and of the recipient soon acquires the 
same force. Usually, and indeed unless the circulation in the donor 
is feeble, no other medium of communication is necessary besides the 
flexible tube and glass canula, as the elastic pump of Aveling's instru- 
ment does not contribute to the force of the flow. The tube and 
canulae should be filled with carbonate-of-soda solution, both to exclude 
air and to prevent clots forming. It is not necessary to measure the 
quantity of blood, as the condition of the recipient furnishes the true 
indications to be followed. 

Peritoneal Transfusion. — To the various kinds of transfusion must 
now be added this form, originally proposed by Ponfick. With anti- 
septic precautions, a trocar with canula is passed through the abdomi- 
nal walls in the linea alba. A flexible tube, with a glass funnel at- 
tached, is then connected with the canula — the trocar being withdrawn 
— and defibrinated blood is poured into the cavity. Excellent results 
follow this practice, which the researches of Bizzozero and Golgi have 
shown to be based on sound physiology. This method has been used 
successfully by Yon Kaczorowski and others in the various maladies 
in which the other modes of transfusion have been employed. Some 
adverse reports have, however, been made. Peritonitis has been 
caused by the procedure, but in these cases the subjects operated on 
may have been unsuitable ones. On the whole, peritoneal transfusion, 
which at one time promised to be a valuable measure, must be regarded 
as still subjudice — if, indeed, its utility is not questionable. 

Dr. Joseph W. Howe, of New York, who has made many valuable 
observations on transfusion, in a recent issue of the "New York 
Medical Journal " (February 3, 1883), announces that no other expedi- 
ent can be properly substituted for the intra-venous injection of blood. 
When life is endangered by haemorrhage, Dr. Howe holds that it is 
not advisable to wait for intestinal or peritoneal absorption, but that 
intra-venous transfusion should be practiced without delay. 

Authorities referred to : 

Albanese. Berliner JcUnische Wochcnschrift, 1870, p. 470. 

Asche. Die neuern Mittheilungen uber Transfusion des Blutes. SchmidVs Jahrbucher 
der gesammten Medicin, vol. cl, p. 329. 

Aveling, Dr. J. H. Lancet, vol. ii, 1872, p. 147. 

Belina. Archives de Physiologie, Normale et Pathologique, 1870, p. 43, et seq. 

Bennett, J. Hughes. The Practitioner, vol. i, p. 211. 



22 HOW MEDICINES ARE INTRODUCED. 

Brown-Sequard. Lectures on the Diagnosis and Treatment of Functional Nervous 
Affections, part i, Philadelphia, 1868. 

Buchser. The Medical Record, October 1, 1869, p. 337. 

Erlenmeyer. Die subcutanen Injectionen der Arzneimittel, dritte Auflage, Neuwied, 
1866. 

Eulenburg. Die hypodermatische Injectionen der Arzneimittel, zweite Auflage, Berlin, 
1867. 

Eulenburg und Landois. TJeber des Transfusion des Blutes, as quoted by Belina. 

Fagge. Guy's Hospital Reports, vol. xix, 18*74, p. 173. 

Gesellius. Die Transfusion des Blutes, eine historische, kritische und physiologische 
Studie, St. Petersburg, 1873. 

Halford. Medical Times and Gazette, vol. x, 1870, pp. 83, 278. 

Hicks. Guy's Hospital Reports, 1869, p. 1. 

Higginson. Liverpool Medical and Surgical Reports, vol. v, p. 104. 

Huter. Berliner klinische Wochenschrift, 1870, p. 470. 

Jtjrgensen. Berliner klinische Wochenschrift, 1871, No. 21. 

Little. The Medical Times and Gazette, London, 1867, p. 354. 

Landois. Berliner Centralblatt. Abstracted in Schmidt'' s Jahrbucher. 

McDonnell. Dublin Quarterly Journal, May, 1870. 

Panum. Experimentelle Untersuchungen ueber Transfusion, Transplantation oder Sub- 
stitution des Blutes, Virchow's Archiv, xxvii, p. 249. 

Pepper, Prof. William, M. D. Paper read before the Medical Society of the State 
of Pennsylvania. 

Routh. The Medical Times, 1849, p. 144. 

Schafer, E. A. The Lancet, December 13, 1879, p. 876. 

Soden. Medico- Chirurgical Transactions, vol. xxxv, p. 143. 

Von Kaczorowski, Dr. Wiener medicinische Wochenschrift, 1880, No. 46. 

Waller. The Practitioner, London, vol. iii, p. 329. 



PAET II. 
THE A CTIOJSTS AND USES OF REMEDIAL A GENTS. 



THOSE USED TO PROMOTE CONSTRUCTIVE 
METAMORPHOSIS. 

ALIMENTS. 

This extensive subject can, in this work, be considered briefly only, 
and from the point of view of therapeutics. The various aliments are 
of the first importance as remedial agents. No satisfactory repair of 
diseased or wasting tissues can take place without a suitable supply 
of healthy blood, and healthy blood is the product of proper food and 
normal digestion and assimilation. 

The Physiological Relations of Food. — The food of man is 
derived from the three great kingdoms of nature : mineral, vegetable, 
animal. It may be conveniently classified into three principal groups : 
1. Mineral constituents — incombustible or unoxidizable : water, phos- 
phate of lime, chloride of sodium, etc. ; 2. Oxidizable — heat-produc- 
ing and force-forming — carbon compounds : fat, sugar, starch, gum, 
etc. Nitrogenous — flesh-forming : albumen, fibrin, casein, etc. ; 3. 
Food adjuncts — alcohol, acids (citric, tartaric, etc.), alkaloids (caffeine, 
theine, etc.). 

The members of the first group will be discussed hereafter, under 
the head of " agents promoting constructive metamorphosis " ; the sec- 
ond group, the most important, will be considered in this relation, with 
the foods ; and the third will have separate treatment under appro- 
priate heads. 

The classification of foods, originally formulated by Liebig, if not 
too strictly adhered to, is of much utility, as indicating the general 
purposes of these substances in the economy — viz. : carbonaceous or 
force-producers ; nitrogenous or flesh-formers. Under the first divis- 
ion are comprehended fat, starch, sugar, etc. ; under the second, sub- 
stances containing nitrogen, as albumen, casein, etc. There is not, 
however, a rigid line of separation between these two classes, for both 



24 RESTORATIVE AGENTS. 

are more or less concerned in the functions attributed to each, but 
their most important position and office are as assigned by the classifi- 
cation. 

The ultimate uses of food are two : to construct tissues or repair 
them when destroyed by wear ; to supply force — muscular, nervous, 
secretory, etc. The reception, digestion, and absorption of food is 
known as the primary assimilation ; the utilization of the material 
for the growth and repair of the tissues, and by the organs, as force, 
constitutes the secondary assimilation. 

The first step in the primary assimilation is the mechanical subdi- 
vision of the food by mastication. The admixture of the saliva with 
the food facilitates the process of mastication, and, as it contains a 
ferment, ptyalin, which has the property of converting starch into 
sugar, a portion of this constituent undergoes conversion ; but, prob- 
ably, the chief use of the saliva is to give a slight alkaline reaction to 
the mass of food. According to the laws of osmosis, the entrance of 
an alkaline fluid into the stomach hastens the formation of the acid 
gastric juice. In the stomach, under the influence of the ferment, 
pepsin, and the acid (hydrochloric) of the gastric juice, the nitrogenous 
materials — the albuminous constituents of the food, the proteids — are 
transformed into peptones. Although fat is necessary to the stomach 
digestion, it does not undergo conversion in the stomach, and escapes 
in a coarse emulsion, with the chyme, into the duodenum. Starch, 
sugar, and gum, also pass into the chyme unchanged, although sepa- 
rated from their proteid envelopes, by the action of the gastric juice, 
except such portions as may diffuse directly into the stomach-veins. 
The peptones, to a large extent, diffuse into the blood from the stom- 
ach, and doubtless, also, such crystalloidal substances as sugar, to 
some extent. The chyme contains parapeptones, starch, fat, sugar, 
and refuse matter remaining undissolved. In the duodenum the acid 
chyme mixes with the alkaline intestinal and pancreatic juices and 
the bile, which are poured out freely as the materials from the stom- 
ach distend the canal. Here the conversion of starch into sugar takes 
place actively, and the fats are emulsionized and to some extent, also, 
saponified. The pancreatic juice not only emulsionizes the fats, but 
separates them into their component fat acids and glycerin, and the 
acids meeting alkaline bases form soaps, which are readily diffusible. 
The action of the bile is also very important. It renders the soaps 
formed soluble, and promotes the emulsionizing of the fats. Its agen- 
cy in the digestion of the fats is well shown in the results of the ex- 
periment for forming a biliary fistula. When the bile is conveyed 
externally, the amount of fat entering the lacteals is much below nor- 
mal, and instead, the fat appears in the stools. In the small intestine 
the proteids which escape conversion in the stomach are transformed, 
under the agency of the bile, pancreatic fluid, and intestinal juice, into 



ALIMENTS— ANIMAL. 25 

peptones and other substances, the starch is converted into sugar, and 
the fats are emulsionized, and in part, also, saponified. These nutri- 
tion materials diffuse into the portal veins and into the lacteals, so 
that, by the time the intestinal contents reach the ileo-caacal valve, 
they are composed, for the most part, of excrementitious matters and 
the refuse of the foods taken. 

When the nutrition of the body goes on in the normal manner, 
there exists a certain ratio between the income and the outcome. The 
income consists of the proteids, fats, carbohydrates, salts and water 
of the food, together with the oxygen absorbed from the atmosphere. 
The outcome is made up of the excreta of the respiratory act, consist- 
ing of carbonic acid and water with a little hydrogen ; of the perspira- 
tion, composed of water and salts ; of the urine, which contains the 
nitrogen excreted from the body and a large quantity of saline matter ; 
and of the faeces, composed of excreta from the immense glandular 
apparatus of the ileum and colon, and from the liver. In a perfectly 
healthy condition of the body, after it has attained its full growth, 
there should be an exact ratio between the income and outcome ; the 
income should suffice to furnish the force necessary for the perform- 
ance of the various functions and to repair the waste of the outcome. 
In an ideal dietary, the amount of the food should be sufficient to 
maintain this ratio at the normal standard. 

As respects classification of foods, for the purposes of this work, 
they may be considered under the natural divisions of Animal and 
Vegetable. 

Animal. — One of the most important articles of diet for the sick is 
Beef, and it should be of good quality : the bone should not exceed 20 
per cent ; the fat should be firm, not yellow, and free from blood, and 
should not be in too great proportion relatively ; the muscle should be 
firm without being tough, not too pale, nor dark-colored, and should 
not present any marbling or lividity on cross-section. The most 
esteemed parts of the beef are the thigh and hip (round, sirloin, fillet), 
the loin and certain parts of the shoulder (rib-roast, porter-house steak, 
etc.). The composition of beef, according to Moleschott's mean of the 
Continental analyses, is as follows (Parkes) : 

Water 734 

Soluble albumen and haematin 2*25 

Insoluble albuminous substances 15*2 

Gelatinous substances 3*3 

Fat , 287 

Extractive matters 1*38 

Creatin 0'068 

Ash 1-6 

The ash contains chlorides of sodium and potassium, potash, soda, lime, 
magnesia, iron (oxide or phosphate), phosphoric acid, sulphuric, chlo- 



26 RESTORATIVE AGENTS. 

rine, and silica. The composition of cooked meat, according to Mole- 
schott (Parkes), is as follows : 

Water 540 

Albuminates 27*6 

Fats 15*45 

Salts 2-95 

It will be perceived from the foregoing analyses that beef contains ali- 
mentary principles the most important for the nutrition of the body. 
When of good quality, neither too old nor too young, the fat and mus- 
cle suitably proportioned, and not altered by disease, and properly 
cooked, it is the best of the animal foods. The loss of lean beef in the 
process of cooking is about one third of the total weight ; of fat beef, 
about one half. The time required for the complete digestion of beef, 
as ascertained by Dr. Beaumont, is two and three fourths to three 
hours. 

Veal is less digestible and less nutritious than beef, and has a laxa- 
tive action, which may, however, be utilized in states of disease. It 
has the following composition : 

Parts. 

Water 630 

Nitrogenous 16'5 

Fat 15-8 

Salts 4-7 

As compared with beef, it is rather slow of digestion, requiring five 
hours or more. It is more albuminous than fibrinous, and abounds in 
gelatin (Fonssagrives). The thymus gland of the veal (sweetbread) 
is, when "plainly cooked (by boiling) and moderately seasoned, a 
very agreeable and suitable dish for the convalescent." — (Pereira.) 

Mutton, although possessing a lower degree of nutritive value than 
beef, is one of the most useful of the animal foods, as it is easily di- 
gested. Many patients, however, experience a marked degree of re- 
pugnance to mutton and can not be induced to make use of any article 
of diet containing it. An evident idiosyncrasy exists in some consti- 
tutions against it, so that taken disguised in any way it disagrees with 
the stomach. It does not continue long in favor as the exclusive arti- 
cle of the meat portion of the diet, even with those who relish it for 
occasional use. According to Church, the following is the composition 
of mutton : 

In 100 parts. 

Water 441 

Albumen 1'7 

Fibrin (true muscle) 5'9 

Ossein-like substances 1*2 

Fat 42*0 

Organic .extractives 1*8 

Mineral matters l'O 

Other substances 2*3 



ALIMENTS— ANIMAL. 27 

Pork contains more fatty matter and more often disagrees than the 
meats above described. Many dyspeptics can not make use of it in 
any form : on the other hand, breakfast bacon may be much relished 
and be easily borne. Pork is rarely prescribed as a diet for the sick, 
but, for convalescents, roasted sucking-pig, which is easily digested, 
may be ordered to vary the food and to stimulate a languid appetite. 
Pork differs from beef and mutton in the relatively greater quantity 
of fat. The loss on cooking pork is 50 per cent. Pork, also, yields 
up to water less solid matter, for, while the solids contained in broth of 
beef and mutton were 27 and 33 per cent respectively, that from pork 
contained only 19 per cent. Beaumont found that roasted pork re- 
quired five and one fourth hours for its solution and digestion in the 
stomach. 

Bacon has the following composition, according to Church : 

In 100 parts. In 1 lb. 

oz. gr. 

Water 22-3 3 248 

Nitrogenous matter 8*1 1 130 

Fat 65-2 10 189 

Salt 3-8 256 

Phosphates, etc 06 42 

Venison is more easily and quickly digested than beef, but does not 
possess the same nutritive value. It is useful as an occasional article 
of diet for the state of convalescence and during a course of special 
animal diet, but for habitual consumption is not equal to beef. 

The domestic Chicken is a most important article of food for sick 
and convalescents. The taste is agreeable, the tissues soft and easy of 
mastication and digestion. " Spring chickens " are more tender and 
delicate than the fully-developed fowl of four or six months. Next to 
the chicken in point of digestibility is the domestic turkey, and after 
this the domestic goose and duck. Certain " game-birds," e. g., the 
prairie-chicken, wild-ducks, woodcock, snipe, are frequently prescribed 
for convalescents, and possess a high degree of nutritive value, but 
are not, of course, adapted for habitual use. 

The viscera of certain animals are sometimes employed as food. 
Allusion has already been made to " sweetbreads," the thymus of the 
calf. The pancreas is very often substituted for the true sweetbread, 
and may, when in proper condition, be used instead of the thymus, 
but it is apt to be stringy and fibrous. The brain, tongue, heart, liver, 
kidneys, and alimentary canal, are occasionally eaten, but are not fre- 
quently prescribed for the sick. Brain is easily digested, and, as it 
contains fats in combination with phosphorus, may be usefully pre- 
scribed in conditions of disease in which these constituents are pre- 
sumed to be deficient in amount. Liver, as ordinarily prepared by 
frying, is very trying to weak stomachs, but this food contains mat- 



28 



RESTORATIVE AGENTS. 



ters which may be utilized in certain diseased states. According to 
Braconnot (Pereira), the composition of liver is as follows : 

Brown oil, containing phosphorus 3*89 

Nitrogenous matter 6-07 

Albumen 20*19 

Salts 1-21 

Water 68-64 

Kidneys, especially as ordinarily prepared, are very difficult of 
digestion, and are unsuited for the sick. As they contain a notable 
quantity of urea and other excrementitious matters, they are for this 
reason objectionable articles of diet. Tripe, the stomach of ruminants, 
is very easily digested and very nutritious, when prepared in the sim- 
ple way, only, which is advisable for invalids. It consists largely of 
albumen. 

In order to test the relative value of the animal foods considered 
in the foregoing pages, Marchal de Calvi (Fonssagrives) made a series 
of elaborate examinations to determine the proportion of water and 
fat to the solid. The results were as follow : 



ANIMAL FOODS. 


Fibst Analysis. 


Second Analysis. 


Solid matters. 


Water. 


Solid matters. 


Water. 


Pork 


294-50 

277-00 
265-50 
263-50 
260-00 


705-50 
723-00 
734-50 
736-50 
740-00 


302-50 
275-00 
263-50 
263-00 
255-50 


697*50 


Beef 


725-00 


Mutton 


73650 


Chicken. 


737-00 


Veal 


744-50 







These analyses assign to pork the first position. In another series 
of experiments M. Marchal used ether to dissolve the fat contained in 
the fibers of these meats. His results are expressed in the following 
figures : 



ANIMAL FOODS. 


Matters soluble in 


ether. 


Matteri insoluble tn ether. 


Beef 


25-437 
14070 
59-743 
29-643 
28-743 


249-563 


Chicken 


248930 


Pork 


242-757 


Mutton 


233-857 


Veal 


226-757 







The following is the most recent contribution to our knowledge of 
the composition of these animal foods (Church) : 

The composition of 1 lb. of 





Beef. 


Mutton. 


Pork. 


Veal. 


Lamb. 


Water 


Oz. Gr. 

8 
1 122 
1 62 
4 340 
350 


Oz. Gr. 
7 16 

385 

1 52 
6 176 
245 


Oz. Gr. 
6 69 

315 

385 
8 
105 


Oz. Gr. 
10 

1 199 

1 82 

2 281 
312 


Oz. Gr. 

8 44 


Albuminoids 


360 


Ossein-like substances 

Fat 


400 
5 263 


Mineral matter 


244 



ALIMENTS— ANIMAL. 29 

According to these experiments, from the chemical point of view, 
beef has the highest nutritive value ; chicken ranks second, and is but 
little inferior to beef ; while veal is the lowest. 

There are certain substances of animal origin which possess great 
importance as dietetic agents, viz., eggs, and milk and its products. 

Eggs. — The following observations refer to the eggs of the domes- 
tic chicken. The egg is composed of four distinct parts : the shell ; 
the membranous envelope of the albumen ; the white ; the vitellus, or 
the yellow. The envelope of the albumen contains nitrogen and sul- 
phur, and phosphate of lime remains after incineration. The white or 
the albumen contains in 100 parts : 

Albumen 12 to 15 

Matter not coagulable , . 5 

Water 80 

The residue after incineration of the albumen is composed of phos- 
phates and sulphates of lime and magnesia, and alkaline carbonates. 
The yellow is a phosphorated fatty matter suspended in water by 
means of an albuminous substance known as vitellin. The yellow 
contains 53*78 parts of water, 17*47 of albumen, and 28*75 of fatty 
matter. According to Gobley (Fonssagrives, from whom most of 
these details have been obtained), the yellow has the following chemi- 
cal constitution : 

Water 51*486 

Vitellin 15*760 

Margarin and olein 21*304 

Cholesterin 0*438 

Margaric and oleic acids 7*226 

Phospho-glyceric acids 1*200 

Sal-ammoniac 0*034 

Salts 7*299 

Extracts 0*400 

Ammonia, nitrogenized matters, coloring matter, lactic acid ....... 0*833 

Eggs consumed by the sick should be fresh and sound. The aver- 
age weight is about two ounces avoirdupois. According to Parkes, 
the following are tests of the freshness and soundness of eggs ; 

"Fresh eggs are more transparent in the center ; old ones at the 
top. Dissolve one ounce of salt in ten ounces of water : good eggs 
sink, indifferent swim. Bad eggs will float even in pure water." 
Fonssagrives recommends the same tests. Eggs coated with beeswax 
dissolved in warm olive-oil (one third beeswax, two thirds olive-oil) it 
is said may be preserved for two years. 

Eggs raw, or better, whipped, are the most digestible of alimentary 
substances, and, as their composition indicates, possess a very high de- 
gree of nutritive value. 

Milk is one of the most important articles of food for the sick, and 



30 RESTORATIVE AGENTS. 

enters largely into the composition of various diets. It is constituted 
essentially of four elements — albuminoid, fatty, saccharine, and saline 
— and therefore contains all the materials necessary for the growth 
and nutrition of tissues. The nitrogenous constituent is casein, an 
albuminoid substance, but which differs from ordinary albumen in that 
it is combined with a larger proportion of alkali, and is not coagulable 
by heat. The fatty element is butter, which contains several neutral 
fats. The composition of butter is not exactly the same in all kinds 
of milk, the difference being due chiefly to a volatile principle upon 
which the special taste of each variety depends. The saccharine ele- 
ment is a crystallizable sugar, known as lactin or lactose, a substance 
which easily decomposes into lactic acid by a process of fermentation 
in which the casein plays the part of a ferment. The mineral con- 
stituents of milk are, chlorides of sodium and potassium, phosphates 
of lime, soda, magnesia, and iron. The most important of these is 
the phosphate of lime. The amount of these salts varies from *5 to 
•8, and rarely exceeds one per cent (Parkes). The French commis- 
sion, appointed by the Prefect of Police of Paris, reported upon the 
analysis of milk made in various countries, and concluded that the 
following figures represent the composition of this fluid when of good 
quality (Tardieu) : 

Water 81 

Total solids 13 

Casein, extractive 

matters, and salts. Butter. Lactin. 

Solids 4-00 4-00 5 



The commission fixed the minimum standard of good milk at — 

Water 88'50 

C Casein, extractives, and salts 4-00 

Solids 11-50 < Butter 2'VO to 3*00 

( Lactin 4'50 



When perfectly fresh, milk is usually neutral in reaction, or it may 
be a little alkaline. After a short time — especially in summer — it be- 
comes acid by a process of fermentation in which the lactin is con- 
verted into lactic acid, and the casein coagulates. The fluid portion 
is called whey, and the semi-solid casein curds. By the fermentation of 
mare's-milk an alcoholic liquor, named koumiss, is prepared in Tartary, 
and has been introduced into medical practice as a remedy for phthisis. 

The proportion of cream in good milk ranges from 10 to 15 per 
cent by volume. By churning, the fat of the cream is collected and 
is then known as butter. This important article of food has the fol- 
lowing composition (Fonssagrives) : 

Margarin 68 

Butyrolin 30 

Butyrin, caprin, and caproin 2 



ALIMENTS— ANIMAL. 



31 



Butter readily undergoes decomposition — becomes rancid — capric 
and butyric acids separating from the base glycerin. This process is 
one of fermentation, and is favored by air, light, and imperfect separa- 
tion of milk in the process of churning. Rancid butter, it need hardly 
be observed, is not suitable for food. 

After the process of churning, which separates the butter, the re- 
sultant liquid, known as buttermilk, contains the casein, lactin, and 
the salts, and is therefore a nutritious article of food. 

As the milk of other animals than the cow is sometimes prescribed 
in medical practice, the comparative chemical constitution of this fluid 
should be studied. The following table (Pereira) shows at a glance 
the difference in composition of the milk from several animals : 



CONSTITUENTS. 


Cow. 


Ass. 


Goat. 


Woman. 




4-48 
3-13 

4-77 
0-60 

87-02 


1-82 
0*11 
6'08 
0-34 
91*65 


4-02 
3-32 
5-28 
0-58 
86-80 


1-52 




3-55 




650 


Salts 


0-45 




87-98 







Whenever fresh and pure milk can be procured, this only should 
be prescribed for the sick, but in large cities it is not always practica- 
ble to obtain it. Under these circumstances " condensed milk " must 
be used. This preparation is made by evaporation of the water of 
the milk and the addition of some sugar. It is found in two forms, 
dependent on the extent to which the abstraction of water is carried : 
as a granular solid and as a soft semi-solid. The addition of warm 
water to the condensed milk furnishes a palatable fluid, of the appear- 
ance and composition of fresh warm milk. 

Fresh milk, boiled and corked up in bottles to exclude the air, will 
keep for a considerable length of time. To prevent fermentation, some 
sulphite of lime may be added to it. For temporary preservation of 
milk in the summer-time, especially when intended for food for infants, 
a little bicarbonate of soda and sugar may be used. 

Cheese contains all the constituents of milk, except the water and 
some salts and lactin removed by expression. In the preparation of 
cheese the casein of the milk is coagulated by rennet, the butter and 
a portion of the lactin and salts are entangled in the meshes of the 
casein, and the mass is subjected to powerful compression. The pe- 
culiar flavor and quality of the cheese depend upon the nature and 
richness of the milk, and upon certain fermentative changes which take 
place, developing volatile, odorous, and sapid constituents. The follow- 
ing table of the composition of cheese illustrates its nutritive qualities : 

Water 368 

Albuminates 33 - 5 

Fats 243 

Salts 54 



32 RESTORATIVE AGENTS. 

It is evidently a concentrated food. The digestibility of cheese de- 
pends in part on its freshness, in part on its composition. When fresh 
and of good quality, it does not ordinarily disagree with the stomach. 
A small quantity of cheese taken after dessert in some cases assists 
digestion ; but many dyspeptics and persons of weak digestion can 
not make use of it under any circumstances. 

Koumiss. — This is a fluid obtained from mare's-milk by fermenta- 
tion, and constitutes the principal part of the food of the people inhab- 
iting a portion of Tartary. It contains alcohol, lactic acid, sugar, 
casein, fat, salts, carbonic acid, and water. In addition to these con- 
stituents, ascertainable by chemical analysis, koumiss contains fragrant 
compounds, volatile, the product, probably, of the decomposition of 
the fat and the reaction of the acids on the alcohol, forming ethers. 
Koumiss of good quality may also be prepared from cow's-milk by the 
process of fermentation, but, as mare's-milk is more nearly allied to 
human milk in composition, it is to be preferred in the preparation of 
this aliment. By variations in the method of preparation, different 
kinds of koumiss are produced, as, for example, thick koumiss, whey- 
koumiss, skimmed-koumiss. According to the different stages to 
which the process of fermentation is carried, there result three degrees 
of quality, No. 1, No. 2, and No. 3. No. 2 differs from No. 1 in con- 
taining more alcohol and carbonic acid, and less sugar and casein. 
These constituents, especially the carbonic acid, impart a liveliness to 
the fluid, so that it effervesces like champagne. In No. 3, the fermen- 
tation having proceeded further, butyric, succinic, and acetic acids are 
produced, and the sparkling quality is enhanced. 

Koumiss is prepared from milk, by the addition of a ferment — 
some koumiss obtained from a previous fermentation or dried kou- 
miss. It is allowed to ferment three days at a temperature of from 
70° to 80° Fahr. It is then a bluish-white liquid, having a sharp, 
acidulous taste, and none of the characteristics of ordinary milk. If 
heated to 100° Fahr., fermentation is definitely arrested. If before 
being heated it is bottled, products corresponding to 1, 2, and 3, 
named above, are the result. Allowed to stand after three days' fer- 
mentation, it separates into three layers : the inferior, caseous ; the 
middle, an acid water ; and the uppermost, a whitish fluid, the best 
koumiss. The alcoholic strength is of course determined by the stage 
of fermentation. The koumiss of two days' fermentation is feeble in 
strength, and hence the product of three days' fermentation is prefer- 
able for medicinal use. 

The quantity of koumiss administered depends on the condition of 
the patient. In cases of feeble digestion, this being the only article 
of food, an ounce every hour will be a sufficient quantity. With 
increased facility in its digestion and assimilation, from a quart to 
a gallon a day may be taken. When it is used in connection with 



ALIMENTS— ANIMAL. 33 

other food, a tumblerful may be administered after each meal. It 
is estimated that each quart of koumiss contains four ounces of solid 
food. 

The tolerance of the stomach to koumiss is remarkable, even in 
cases of gastralgia. It improves the appetite, and excites the action 
of the kidneys. The patients experience a pleasing exhilaration, due 
probably to the combined action of the carbonic acid and the alcohol. 
Decided intoxication undoubtedly may result from the use of a large 
quantity by any one unaccustomed to it. It also causes somnolence 
during the day, and favors sleep at night without leaving any after- 
headache. Its most important action is the increase of the body 
nutrition ; and hence its utility in the treatment of phthisis, indiges- 
tion, and the various cachexias. Jagielsky says that he has had pa- 
tients gain as much as ten pounds a month when no other food was 
taken. 

Fish. — A great many varieties of fish are used as foods to which 
it is necessary to allude in general terms only. Salted fish is not a 
suitable article of food for the sick : it is difficult of digestion, and 
possesses but slight nutritive value. Fresh fish, however, properly 
cooked, is, as a rule, easy of digestion, and furnishes a pabulum of a 
valuable kind in diseases of certain textures. The following is the 
composition of fish as compared with beef, according to the analysis 
of Fr. Schulze : 



CONSTITUENTS. 

Fibrin, cellular tissue, nerves, and vessels 

Albumen 

Alcoholic extract and salts 

Aqueous extract and salts 

Phosphates 

Fats and loss 

Water » 



15-0 


12-0 


4-3 


5-2 


13 


1-0 


1-6 


1-7 


traces. 


traces. 


10 


a 


77-5 


80-1 



The commonly-received opinion, that fish is a more highly-phospho- 
rated food than beef, does not receive support in this analysis. White- 
fish, shad, bass, and fresh mackerel, are more suitable for the sick than 
cod, salmon, or eels. They should be prepared and eaten as soon as 
possible after being taken from the water, and should be either broiled 
or boiled. Only at the time of the ripening of the milt and roe are 
fish in a suitable condition for the dietary of invalids. At the time 
of spawning, and immediately after, the flesh of fish is watery and 
semi-gelatinous. 

Oysters rank among the most digestible of foods, and are usually 
easily borne by the most delicate stomach. According to Fonssagrives 
the French oyster contains about 12 - 6 parts of solid matters, consist- 
ing of osmazome, chlorides of sodium and magnesium, sulphates of 
lime and magnesia, fibrin, albumen, and gelatin. They are more easily 
3 



34 RESTORATIVE AGENTS. 

and quickly digested when eaten raw, or broiled, but stewed is the 
most common form for use in disease. In cases of great irritability 
of the stomach, the most easily borne oyster-soup is prepared by the 
addition of the liquor to boiling milk. 

Vegetable. — The most important members of this class of foods 
are the cereal grains — wheat, rye, corn, rice, buckwheat, oats, and bar- 
ley. The universality of its consumption and its nutritive value place 
wheat-bread in the first position as an article of diet. The composi- 
tion of wheat-flour is as follows : 

Water 140 

Fatty matters 1*2 

Gluten 12-8 

Albumen 18 

Dextrin, sugar 7*2 

Starch 59*7 

Cellulose VI 

Salts (potash, soda, lime, magnesia, phosphoric acid, etc.) 1*6 

In the preparation of wheat-flour, the bran is separated. Important 
constituents of the wheat are thus removed, as the following analysis 
of the bran shows : 

Water 103 

Fatty matters 2 82 

Gluten 10-84 

Albumen 1'64 

Dextrin, sugar 5 - 8 

Starch 22'62 

Cellulose 4398 

Salts 2-52 

The internal envelope of the wheat-grain contains also a ferment, 
know as cerealin, which has very active properties. As the propor- 
tion of bran to flour is as sixteen to eighty, it is obvious that consider- 
able loss accrues in the preparation of superfine flour. Wheat-bread 
made from superfine flour is easy of digestion, owing to its lightness 
and sponginess permitting a rapid effusion of the gastric juices through 
every part of it. Most of it is also available for nutrition ; there is 
little residuum ; hence the constipation which attends its use in large 
proportion relatively to the other constituents of the diet. When 
flour is unbolted (bran not separated), an increase of nutritive value is 
obtained, at the expense, however, of digestibility. A large part of 
the bran, probably, resists the action of the gastric juice, and hence, 
irritating the mucous membrane, increases by reflex action the secre- 
tions and peristaltic movements. 

Whole wheat-grains, under the name of " cracked wheat," is fre- 
quently prescribed as an article of diet for invalids. It is boiled until 



ALIMENTS— VEGETABLE. 35 

the envelope of the grain is burst open, and is eaten with cream and 
sugar. Obviously such a combination forms a food of great excel- 
lence. The special advantage which it possesses, besides its nutritive 
value, is its laxative action. 

Ordinarily, wheat-bread made of superfine flour is to be preferred 
for the use of invalids. To obviate the constipating action of such 
bread, and to obtain a laxative effect, various expedients are adopted. 
Bran, rye, and corn meal, and, in some kinds of bread, molasses, are 
added to the dough, forming those varieties known as Graham bread, 
brown bread, and Boston brown bread. 

The important quality of lightness is imparted to wheat-bread by 
thorough incorporation of carbonic-acid gas with the dough. Two 
processes are employed for this purpose : By the addition of yeast, 
fermentation takes place at the expense of a portion of the starch, and 
carbonic acid and alcohol are produced. By mechanical means, car- 
bonic acid obtained from other sources is mixed with the flour. The 
latter is known as " aerated bread." Obviously, the mechanical pro- 
cess is more economical because there is no loss of flour. It furnishes 
usually a lighter and drier bread, and is more easily digested. Bread 
made by the fermentation process is not unf requently moist and heavy, 
and sour, because the fermentation has proceeded beyond the alcoholic 
stage. " French bread " is lighter, drier, and better baked, than ordi- 
nary baker's fermented bread. Warm, fresh bread is not suitable for 
invalids. It can not be so perfectly masticated as older bread, and, 
not reaching the stomach in a state to permit diffusion through the 
mass of the gastric juices, lies unchanged for hours. 

According to Smith, the ultimate composition of wheat-bread is 
as follows : 

Water 37'0 

Starch . 4*7'4 

Sugar , 3*6 

Fat 1-6 

Salts 2 3 

Macaroni stewed in milk is sometimes prescribed for the sick. 
Prepared with butter, cheese, and condiments, it is not an appropriate 
food for invalids. In composition it consists chiefly of gluten, and of 
course starch — but in less proportion than in bread — and of fat. The 
cylindrical tubes in which it occurs are formed by passing the paste 
of flour (gluten) through perforated plates. 

Bread requires from three and a half to four hours for complete 
digestion. Brown bread digests somewhat more slowly. 

Barley is but rarely used as food in this country. It is occasionally 
prescribed for the sick in the form of infusion — a demulcent drink — 
and is frequently added to soup. It has the following composition 
(Smith) : 



36 RESTORATIVE AGENTS. 

Water 150 

Starch 69*4 

Sugar , 4'9 

Fat 2 4 

Salts 20 

Albuminous substances 6 3 

Hice is one of the most digestible of vegetable foods, requiring, 
when boiled, about one hour. Its nutritive value is not equal to 
wheat, because it consists chiefly of starch. The following is its 
proximate constitution : 

Water 13*0 

Nitrogenous matter 6 - 3 

Starch 791 

Sugar 0*4 

Fat 0-7 

Salts 0-5 

Rice-water, or decoction of rice, like the corresponding preparation 
of barley, is used as a demulcent drink in fevers and intestinal disor- 
ders. Boiled rice is frequently prescribed as a diet for invalids with 
weak digestion, and is enriched by the addition of milk and cream, 
and eggs (rice-pudding). 

A comparison of its chemical composition with that of wheat or 
corn will show that it is by no means equal to them in nutritive value. 
It is obviously unfitted to sustain life alone, and hence in rice-eating 
countries it is mixed with fat or other foods supplying principles in 
which it is deficient. 

Corn has the following composition (Letheby, Smith) : 

Water 14'0 

Nitrogenous matter (albumen) 11 *0 

Starch - 64-7 

Sugar 0*4 

Fat 81 

Salts 1-7 

It is not so readily digested as starch, requiring about three hours. 
Corn, when green, is prepared for the table by boiling, and is eaten 
with salt and butter, or milk. If young and tender, and sufficiently 
cooked, it is a digestible and nutritious food ; but, if the grain is too 
mature, it resists the action of the intestinal juices, and passes un- 
changed. 

The mature grain, deprived of the heart and husk, is known as 
hominy. Thus prepared and thoroughly boiled it is an esteemed 
article of diet, ranking in nutritive value a little above boiled starch. 
Mush is boiled corn-meal, and is eaten with milk, and is sometimes 
fried. It is important that mush be well cooked. Corn-meal is also 
eaten in the form of bread and cakes. These various preparations of 



ALIMENTS— VEGETABLE. 37 

corn are liable to cause intestinal disorders, and are hence improper in 
cases of irritable mucous membrane, and in diarrhceal diseases. For 
this reason corn-bread is sometimes prescribed in cases of constipation 
dependent on diminished secretion of the intestinal mucous membrane, 
and torpor of the muscular layer of the bowel. The starch of corn is 
not unfrequently prepared for invalids in the form of blanc-mange. 

Oatmeal corresponds in physical qualities and composition to corn- 
meal. Its proximate composition, according to Smith, is as follows : 

Water 15*0 

Nitrogenous matter 12*6 

Starch 58*4 

Sugar 5*4 

Fat 5 6 

Salts 3 

It is not at all generally used as an article of diet in this country. It 
is prescribed in the form of gruel as a delicate food. Boiled for a 
long time, the oatmeal swells up and thickens, forming a blanc-mange, 
which may be eaten with milk, or butter, or cream, and sugar and 
aromatics. 

TJie Potato, next to wheat, is the most important food derived 
from the vegetable kingdom. Its conrposition is affected by its source 
and variety, and by the soil in which it is grown. The specific gravity 
of the potato affords an index of its nutritive value, for, the heavier, 
the greater the quantity of starch it contains. For the sick, watery 
potatoes are unsuitable. When cooked, the tuber should be mealy and 
dry. The following is the composition of the potato : 

Water 75'0 

Nitrogenous matter 2*1 

Starch 18"8 , 

Sugar 3"2 

Fat 0-2 

Salts 0-1 

According to some authorities, the potato contains free citric acid. 
The salts are rich in potash. According to Letheby, the composition 
of the sweet-potato is as follows : 

Starch 160 

Sugar 10-0 

Albumen 1*5 

Gum 11 

Fat 03 

Salts 2'9 

Water. .. , 682 

These analyses indicate that the sweet-potato possesses the higher 
nutritive value. 

Starch, Sago, Arrowroot, and Tapioca, differ from the preceding 



38 



RESTORATIVE AGENTS. 



vegetable foods, in that they contain no nitrogen. They are digested 
in from one to two hours. They are largely used in the preparation 
of diets for the sick, but are insufficient in themselves to maintain for 
any considerable period the vital functions. Hence they are prepared 
and eaten with sugar, milk, cream, butter, and aromatics. 

Turnips, Parsnips, Carrots, Onions, Asparagus, Beets, Cauliflower, 
and Cabbages, are but rarely prescribed for the sick. Nevertheless, 
some information in regard to their composition and digestibility may 
not be misplaced. According to Smith, the following represents the 
composition of 



Turnips. 



Water 91-0 

Sugar 2*1 

Nitrogenous matter. . . 1*2 

Fat — 

Starch 5'1 

Salts 0'6 



Water 83 

Sugar 6-1 

Nitrogenous matter. . 1*3 

Fat 0-2 

Starch 8-4 

Salts 1-0 



Parsnips. 



Water 82'0 

Sugar 5*8 

Nitrogenous matter. . . 1*1 

Fat 05 

Starch 9'6 

Salts 1-0 



Beets differ from the above chiefly in the quantity of sugar. The 
following is the analysis of Payen : 

Water 83*5 Nitrogenous matter 1*5 

Sugar 10*5 Pectose, etc 08 

Salts and pecten Z ,Y l 

All of the members of this group are deficient in nutritive value, 
and are besides slow and difficult of digestion, requiring from three to 
five hours for complete solution. 

Ripe fruits, as grapes, apples, pears, peaches, oranges, lemons, etc., 
possess but little nutritive value, as they contain only about 10 to 15 
per cent of solid matters. In composition they are represented by 
sugar, free acid (tartaric, citric, etc.), nitrogenous matters, and salts. 
They differ, of course, in the peculiar flavoring matters which give to 
each fruit its special taste. Dried fruits, as dates, figs, and raisins, are 
relatively much more nutritive, because they contain a larger percent- 
age of sugar. Under the head of dietetic management of diseased 
states, some further remarks will be made on the use of the fresh and 
dried fruits. 

SPECIAL PLANS OF DIET. 

The food-supplies to the organism may be so managed as to secure 
very definite therapeutical results. By increasing or diminishing the 
whole amount of foods ingested, by variations in the quality and char- 
acter of them, and by the employment of some special and restricted 
methods of feeding, cures are effected not attainable by medicinal 
treatment. 

Denutrition. — The amount of food necessary for bare subsistence 
has been pretty accurately determined. During the siege of Paris the 



DENUTRITION. 39 

daily ration was at one time reduced to less than ten ounces of bread 
and one ounce of meat daily. Br. Edward Smith ascertained that the 
daily amount of food barely sufficient to maintain life among the fac- 
tory operatives must contain 2 '84 ounces of nitrogenous matter, and 
19-25 ounces of carbonaceous. Pettenkofer and Voit give, as the 
necessary amount of food required by an adult when at work, 5*22 
ounces of nitrogenous and 22*38 of carbonaceous matter. Letheby 
furnishes the following table as the result of his investigations on 
this point : 

Nitrogenous, Carbonaceous, 

DaUy diet for ozs « 02S - 

Idleness 2-67 19*61 

Ordinary labor 4'56 2924 

Active labor 5"81 34'97 

The ration of the United States soldiers imprisoned at Andersonville 
consisted of one third pound of bacon and one pound and a quarter of 
unbolted corn-meal. This amount and quality of food were insufficient 
to maintain the bodily functions in a healthy state, and hence vast 
numbers died of scorbutus, diarrhoea and dysentery, and hospital gan- 
grene. From these data we are enabled to form an estimate of the 
amount and kind of food necessary to maintain life in those cases of 
disease in which it is desirable to apply the method of denutrition. 

Physiological Effects of Insufficient Food. — Intestinal uneasiness, 
more or less pain, borborygmi, and a feeling of hunger, are among the 
first symptoms of an insufficient supply of food. The secretions of the 
intestinal canal diminish, digestion becomes difficult, and constipation 
results. The respiratory movements are diminished in frequency and 
volume, and the exhalation of carbonic acid notably declines. Ac- 
cording to Dr. Edward Smith, while under an ordinary diet the daily 
excretion of carbonic acid amounts to thirty -four ounces, under an 
almost complete abstinence it falls in twenty-four hours to twenty-two 
ounces. The blood suffers a notable diminution in its amount ; the 
quantity of water augments, and the number of blood-globules greatly 
diminishes. Meanwhile the blood loses its plasticity, and a tendency 
to hemorrhagic extravasations is developed. The urinary secretion 
also lessens in amount ; the urea and uric acid diminish, but the hip- 
puric acid rather increases ; the chlorides after some days almost dis- 
appear, but the sulphuric and the phosphoric acids persist. As a re- 
sult of the very obvious decline in the function of assimilation, the 
temperature of the body falls some degrees below the normal. The 
functions of the nervous centers undergo a marked derangement. 
Giddiness, vertigo, hallucinations, ensue, and are coincident with a 
fatty degeneration of the cells of the gray matter. The subcutaneous 
fat disappears ; the muscles lose a considerable part of their substance. 
The muscular substance of the heart diminishes proportionally. The 



40 RESTORATIVE AGENTS. 

bones do not suffer much loss. The extreme degree of loss attainable 
with safety is from 40 to 50 per cent of the average weight. 

Therapy. — Diminution in the gross amount of aliment and a rear- 
rangement of its constituents are of the first importance in the treat- 
ment of obesity. The tendency to obesity may be hereditary or ac- 
quired. In the former it is cured with difficulty ; in the latter a suit- 
able regimen will accomplish much. The fat accumulates under the 
skin, in the visceral cavities, and in the interstices of organs. Two 
doctrines have been held by physiologists with regard to the mode of 
production of fat in the organism : one, that the fat received in the 
food is simply stored up ; the other, that it is also produced by the 
transformation of some of the other constituents of the food. If the 
first theory contained the whole truth, it would be necessary only in 
the treatment of obesity to withdraw from the patient's aliment all 
fatty substances ; but it is found in practice that this is insufficient, 
and that fat is created out of the starchy and saccharine elements of 
the food. Hence it is necessary in the treatment of corpulence to in- 
terdict not only fats, but the starches and sugar. This was the method 
of Hippocrates ; but it has been revived in our generation by Mr. 
Banting, and is now usually called Bantingism. As a guide to this 
method of treatment I quote the rules of Mr. Banting : 

" For breakfast, at 9 a. m., I take five or six ounces of beef, mutton, 
kidneys, broiled fish, or cold meat of any kind except pork or veal ; a 
large cup of tea or coffee, without milk or sugar ; a little biscuit or 
one ounce of dry toast ; making together six ounces of solid and nine 
of liquid. For dinner, at 2 p. m., five or six ounces of any fish except 
salmon, herring, or eels ; any meat except pork or veal ; any vegetable 
except potato, parsnip, beet, turnip, or carrot ; one ounce of dry toast ; 
fruit out of a pudding not sweetened ; any kind of poultry or game, 
and two or three glasses of good claret, sherry, or madeira — cham- 
pagne, port, and beer, forbidden ; making together ten or twelve 
ounces solid and ten liquid. For tea, at 6 p. m., two or three ounces 
of cooked fruit, a rusk or two, and a cup of tea without milk or sugar ; 
making together two to four ounces solid and nine liquid. For sup- 
per, at 9 p. m., three or four ounces of meat or fish, similar to dinner, 
with a glass or two of claret or sherry and water, making together 
four ounces solid and seven liquid." 

Sugar, Mr. Banting finds, is one of the most active of fat-forming 
foods. His method consists in the avoidance of sugar, fat, and farina- 
ceous substances — in fact, all roots or vegetables grown underground. 
Although this system was pursued by Mr. Banting with success, it 
can not always be persisted in without danger. The dietary is want- 
ing in the amount both of carbonaceous and nitrogenous constituents 
necessary to the healthy action of the organism. Therapeutically it is 
adapted to the end in view — the denutrition of the body ; but it is, 



DRY DIET. 41 

physiologically considered, unsafe to be long persisted in, because in- 
sufficient for the work of the body. 

Aneurism. — A low diet, with absolute rest, is of great value in the 
treatment of internal aneurisms. The diet should be only sufficient to 
maintain life. The method of Valsalva consisted in such a diet and 
frequent and free bleedings, with rest. Mr. Tufnell's plan of diet, 
which has proved very satisfactory in this disease, consists in two 
ounces of liquid and four ounces of solid food morning and evening, 
and four ounces of liquids and six ounces of solids at noon, and with 
this dietary is associated absolute repose in the recumbent posture. 

To diminish the Volume of the Foetus in cases of Dystocia has 
been suggested by Merriman, Baudelocque, and Moreau, and was suc- 
cessfully practiced in two cases by Depaul. The method consists in 
free abstraction of blood, and the lowest diet consistent with the exist- 
ence of life. At the present time the methods of inducing premature 
labor have been so perfected as to quite take the place of the practice 
of Depaul. 

Syphilis. — It is certainly an eminently rational expedient to relieve 
the organism of a virus by a continuous and gradual molecular de- 
struction and a renewal of the anatomical elements. Such is the hun- 
ger-cure of syphilis, an Arabic method of treating that disease. Yery 
satisfactory results have been attained by this means ; but the self- 
denial and even suffering which it requires render it exceedingly un- 
popular with patients. 

Dry Diet. — This consists in a decided diminution or a temporary 
total suspension of liquid of all kinds. It is well known that water 
constitutes about two thirds of the gross weight of the adult body. 
The quantity of water daily lost from the body has been estimated at 
about four and a half pounds. Dalton thinks that fifty-two fluid- 
ounces is the quantity required by a man in full health exercising in 
the open air. The difference between this and the amount of loss is 
made up by the water contained in food, especially in the succulent 
vegetables. Indeed, it is quite possible for the vegetarian, whose diet 
consists of fruits and vegetables, to receive sufficient water in this way 
for the purposes of his organism. 

Physiological Effects of Dry Diet. — Besides the tormenting sensa- 
tion of thirst, the food is swallowed with difficulty and the appetite is 
lost. Absorption of the interstitial fluids takes place, and the volume 
of the organs undergoes diminution. The subcutaneous veins flatten, 
and the pulse loses in tension and amplitude ; the saliva becomes vis- 
cid ; the urine reddens and deposits a sediment ; constipation ensues, 
and a rapid emaciation takes place (Fonssagrives). 

Therapy. — As the withdrawal or decided diminution of fluid causes 
rapid absorption of the interstitial water, this method of treatment 
may be resorted to with advantage in cases of dropsy. It has been 



42 



RESTORATIVE AGENTS. 



used with success in dropsical accumulations of the serous cavities, 
and is adapted to the treatment of hydrothorax, hydrops pericardii, 
and ascites. 

Fonssagrives reports two cases of diabetes insipidus (polyuria) de- 
cidedly benefited by the dry diet. This method of treatment is indi- 
cated in the first stage of fibroid kidney, in which disease the thirst is 
excessive, the stomach rather intolerant of fluid, and the flow of watery 
urine excessive. 

Dilatation of the Stomach, besides other appropriate treatment, is 
benefited by water-free food. That form of dyspepsia and dilatation 
of the stomach produced by excessive beer-drinking is much improved 
by abstinence from drinks of all kinds. The ice-water dyspepsia, a 
malady quite common during the summer months of this country, may- 
be entirely relieved by dry diet. 

Vegetable Diet. — The special indications for the use of vegeta- 
ble food are reserved for the sections on diet in special diseases. It is 
necessary, however, to say something here of the grape-cure, a method 
of treatment much in vogue in some parts of France and Germany. 

The grape-cure consists, according to Carriere, of a diet exclusively 
of grapes. They are taken many times a day to repletion. It is usual 
to commence with a pound, and progressively to increase the amount 
to two, three, six, and eight pounds, a limit which is not exceeded. 
The first grape-repast, which may be the most abundant, is in the early 
morning, but not as are the others, eaten in the vineyard. Another is 
taken at the time of the morning meal (corresponding to our break- 
fast) ; the next after the morning walk at the time of the dejeuner 
(noon), consisting of bread and water ; another before the usual din- 
ner-hour (evening), and finally before retiring. The treatment is con- 
tinued during the five or six weeks of the duration of the grape-crop. 

The grape-cure is used with success in plethora of. the portal circu- 
lation, diarrhoea, dysentery, hemorrhoids, and engorgement of the 
spleen. It renders much service in the principal dyscrasiae, as scrofula, 
tuberculosis, and phthisis, gout, and cutaneous diseases (Carriere). The 
influence of change of air, of new scenery, and of the hygienic rules 
enforced at these resorts, should not be ignored in an estimate of the 
value of this method. 

The composition of the ripe grape is, according to Smith, as follows : 



Soluble. 

Grape-sugar 13*8 

Tartaric acid 1'12 

Nitrogenous matter "8 

Gum, fat, etc , *5 

Salts *36 

Water 79-8 



Insoluble. 

Skins, stones, etc 2*6 

Pectose. "9 

Mineral water *12 



The quantity of nitrogenous matter is insufficient for the needs of the 



ANIMAL DIET. 43 

organism, hence the addition of bread and water to the diet of the 
grape-cure. 

Animal Diet.— The more or less exclusive use of animal food im- 
proves the quality of the blood by increasing the number of the red 
corpuscles. The urine rises in specific gravity, and the urea and uric 
acid are increased in amount. According to Liebig, force in excess is 
developed from a diet of animal food, whence a nation of animal feed- 
ers must be a nation of hunters, possessing a savage disposition. 
Those who consume largely of animal food are not fat, but have a 
high degree of muscular activity. They are tormented by imperious 
venereal desires, and are irritable in temper. 

Therapy, — A diet of animal food is specially indicated and of great 
utility in diabetes. As the vegetables and fruits contain sugar, and 
starch which is readily transformed into sugar, they are interdicted in 
this disease. A method of treating diarrhoea long practiced in Rus- 
sia, and popularized by Trousseau, consists in the use of a pulp of raw 
meat. A bit of fillet of beef is deprived of all fat and aponeurotic 
fiber, minutely divided, and beaten in a mortar until all traces of fibers 
have disappeared. It is then pressed through a fine sieve and mixed 
with sugar, conserve of roses, or suitable aromatics, or seasoned with 
salt and pepper to the taste. It may be administered in this form 
with fruit- jelly, or spread on thin pieces of bread. A beefsteak has- 
tily broiled on a hot fire, so as to retain its juices, may be treated by 
the same method, or the raw beef scraped to a pulp, rejecting the 
fiber, may be thrown on to a hot skillet for a few seconds to give an 
odor and appearance of cooked meat. This method, which has been 
used especially in the treatment of diarrheal diseases of early life, is 
equally efficacious in the chronic diarrhoea of adults. The chief ob- 
jection to this mode of alimentation is the great frequency with which 
tape-worm follows. 

In states of debility arising from any cause in which it is neces- 
sary to supply an easily-digested nitrogenous aliment, raw beef may 
be used in this way. 

Blood is so rich in the elements of nutrition that its employment 
as a food in wasting diseases need not excite surprise. "Within a few 
years it has been much used in the treatment of phthisis, the patients 
resorting to the butchers' shambles to quaff the blood as it flows away. 
On the part of the patients, it is supposed to possess some special cura- 
tive power ; but it is only as a nutrient that its use is justifiable. Be- 
sides the unpleasant associations which must necessarily be connected 
with blood-drinking, there is danger of swallowing parasites. That 
it improves nutrition, often to a remarkable extent, is undeniable. It 
must therefore remain a question to be decided by the patient whether 
he will incur the risk of infection by parasites, to be benefited by 
drinking a valuable nutrient, 



44 RESTORATIVE AGENTS. 

As the serum of the blood contains the most important of the nu- 
tritive elements of the blood, the use of this has been proposed in lieu 
of the latter, administering one ounce three times a day. Blood-serum 
is said to be an efficient vermifuge. It must be taken fasting. 

Milk-Diet. — The numerous and important applications of milk- 
diet in the treatment of certain forms of disease render it necessary to 
devote considerable space to the consideration of this subject. Milk 
is a food already prepared, and therefore needs no intervention of un- 
skillful cooks ; it can be obtained everywhere ; few patients are dis- 
inclined to take it. 

Physiological Effects of Milk-Diet. — In the use of a diet for a long 
time exclusively of milk, great difficulty is often experienced in over- 
coming the repugnance of the patient. Although as a rule it is taken 
with readiness at first, after a time it begins to pall upon the appetite, 
and the greatest resolution is necessary on the part of the patient in 
order to continue it. A distressing sense of emptiness is experienced 
at the epigastrium. The mouth becomes pasty, and the tongue is 
coated with a thick, whitish fur. Constipation, sometimes exceedingly 
obstinate, occurs, and the stools are hard and of an ochre-yellow color. 
Occasionally diarrhoea is produced, but this is due to the fact that the 
milk disagrees and is not digested. The urinary secretion is increased 
in amount, but this is due simply to an increased flow of water. Al- 
though milk contains all the constituents necessary for the nutrition 
of the body, when it is used as an exclusive article of diet in the case 
of those accustomed to a full mixed diet, a decided diminution in the 
weight of the body takes place. After a time, however, the waste 
ceases, and the weight continues at a uniform level. The interference 
of a milk-diet with nutrition is more decided when skimmed milk is 
used — a form in which it is more usually administered in intestinal 
disorders. The pulse is quickened and the arterial tension lowered ; 
but a fall in the pulse-rate takes place when the body ceases to lose 
weight. A marked degree of debility is experienced by some persons, 
so that they are unable to take exercise. In two cases in which I used 
this method with signal success — chronic eczema, and chronic ulcer of 
the stomach — the patients, both females, experienced vertigo and faint- 
ness, and Mitchell mentions a case in which from the same cause he 
was compelled to discontinue the milk. Ordinarily, however, nothing 
more than weakness is experienced. 

Therapy.— Pecholier, Carel, Mitchell, and all who have treated of 
the milk-cure, insist upon the suspension of all other food and drink. 
The quantity to be taken will vary with the constitutional peculiarities, 
habits of life, and probably the mental condition of the patient. As 
milk requires about three hours for its complete digestion, this fur- 
nishes a rule for its administration. One gill, or four ounces, every 
three hours, beginning on rising in the morning, is the rule which I 



MILK-DIET. 45 

have followed with success. As soon as the patient can take a suffi- 
cient quantity, one or two tumblerfuls four times a day may be ordered. 
From a quart to two quarts is the daily amount which will be taken 
usually by the patient. It is better administered slightly warm. 

In many cases of stomach and intestinal disorders, it is better to 
give skimmed milk. The milk should stand for twenty-four hours in 
a cool place, and then all the cream which has risen should be care- 
fully removed. Sometimes, says Pecholier, when crude milk disagrees 
with or is disgusting to the patient, it may be boiled. The digestion 
of the milk, says the same authority, when it is poorly borne, may be 
aided by the addition of lime-water, bicarbonate of soda, and other 
alkalies, Mitchell has added lime-water for the first few days under 
the same circumstances, and, in order to overcome the patient's repug- 
nance to the taste, has faintly flavored the milk with a little coffee 
or caramel ; but he prefers to give it alone as soon as possible. My 
own observation has been, that milk is better borne when given for 
the first few days with lime-water, in proportion of one fourth of the 
latter. 

For the nourishment of infants deprived of their natural food, no 
substitute is better than cow's-milk diluted with about one third of 
water and sweetened with sugar, in order more closely to assimilate it 
in composition to the human milk. This should be given at a tem- 
perature of 100° Fahr., and at intervals of three hours. No other 
food than milk is proper for infants up to the eighth month of life, for 
their digestive organs are not adapted to the digestion of the farina- 
ceous foods so commonly supplied them. If the milk be rejected, the 
addition of lime-water may enable the infant to retain and digest it. 

In the treatment of disease in the adult with skimmed milk, the 
time for suspension of the diet depends on several conditions. Carel 
begins to make additions after two or three weeks ; Pecholier when 
the effects sought for in the treatment are obtained. Mitchell formu- 
lates his method as follows : " My own rule, founded on considerable 
experience, is this : Dating from the time when the patient begins to 
take milk alone, I wish three weeks to elapse before anything be used 
save milk. After the first week of the period, I direct that the milk 
be taken in just as large amount as the person desires, but not allow- 
ing it to fall beloio a limit which, for me, is determined in each case 
by his ceasing to lose weight. Twenty-one days of absolute milk-diet 
having passed, with such exception as I shall presently mention, I now 
give a thin slice of stale white bread thrice a day. After another 
week I allow rice once a day — about two tablespoonfuls — or a little 
arrow-root, or both, as circumstances may dictate. At the fifth week 
I give a chop once a day ; and, in a day or two, another at breakfast ; 
and after the sixth week I expect to return gradually to a diet which 
should still consist largely of milk for some months." My own rule 



46 RESTORATIVE AGENTS. 

has consisted in the gradual addition of other diet after the cessation 
of symptoms for which the milk-treatment was instituted. 

To overcome the obstinate constipation which sometimes attends the 
milk-cure, a variety of measures have been proposed. Carel advises 
coffee in the morning. Mitchell recommends a half -grain of aloes at 
night, and Saratoga- water in the morning. I find that fifteen drops of 
the tincture of physostigma at night will often succeed, but more fre- 
quently prescribe with success a teaspoonf ul of Epsom salts dissolved 
in a half -tumblerful of ice-water to be taken on rising. 

The milk-cure is especially adapted to the treatment of obstinate 
stomach affections. It has succeeded admirably in the treatment of 
dyspepsia, gastric catarrh, gastralgia, gastric ulcer, and has procured 
marked amelioration in cases of scirrhus of the stomach. In chronic in- 
testinal indigestion, obstinate and persistent enteralgia, chronic diar- 
rhoea, and dysentery, it has proved very efficacious. 

The treatment of ascites by a milk-diet appears to have been of an- 
cient origin, for Hippocrates distinctly refers to it, but the revival of the 
practice in modern times is due to Chrestian, of Montpellier, who demon- 
strated the utility of this practice in a number of cases (Fonssagrives). 
Pecholier and Chairon also report cases of success treated by this 
method. In cases of ascites the result appears to be due to the profuse 
alvine and urinary discharges which are caused by the milk-diet in this 
disease. Pecholier also reports cases of general anasarca due to cardiac 
disease, much benefited by this treatment. In England, Donkin has 
issued a monograph on the skim-milk treatment of albuminuria, with 
successful cases. This method has also been extended to diabetes, and 
reports of cures are not wanting. 

Eczema, connected with acid indigestion, has been successfully 
treated by an exclusive skim-milk diet in my hands, and Mitchell reports 
an analogous case. Gout and gouty affections have also been much 
improved, and the diathesis apparently removed, by a persistent use of 
the milk-cure. Lastly, aneurism and cardiac disease (irregular and 
tumultuous action due to valvular lesions) have been benefited by a 
milk-regimen. 

Whey-Cure. — This mode of treatment is conducted in the moun- 
tain health-resorts of Switzerland and Germany, and is usually connected 
with the grape-cure. As whey contains so little of the nutritious ele- 
ments of the milk, we may conclude with Lebert that the hygiene and 
climate of these mountain-resorts do everything for the patients, and if 
they improve they do so in spite of the whey. 

Koumiss-Cure. — Koumiss differs from whey in containing the nutri- 
tive constituents of milk, and from milk itself in the important respect 
that it is in addition an effervescing alcoholic fluid. Koumiss possesses 
great value in the treatment of phthisis, chronic bronchitis, the low 
stage of fevers, the stage of convalescence from acute diseases, and in 



BUTTERMILK-CURE. 47 

fact in all adynamic states in which the combined effect of alcohol and 
nutrients may be desirable. 

Buttermilk-Cure. — To the efforts of Dr. Ballot, of Rotterdam, is 
due the knowledge we now possess of the value of buttermilk as a food 
for infants. The relative composition of buttermilk and mother's-milk 
is given in the following table : 



CONSTITUENTS. 


Buttermilk. 


Mother's-milk. 




43-8 

236 

2-0 

5-6 

921-75 

78-25 

2*75 


34-3 




482 




23-3 


Salts 


2-3 




883-6 




116-4 




nil. 







It is probably in consequence of the presence of lactic acid, as Dr. Ballot 
suggests, that buttermilk is easily digested. His manner of preparing 
the food for infants is as follows : To a pint of buttermilk is added a 
spoonful of wheat-flour. This is boiled a few minutes. The pap must 
be thin. To this quantity of buttermilk, after it is boiled, is added half 
a drachm of sugar. It should have a sweet taste. 

In the beginning some teaspoonf uls are given to habituate the infant 
to the smell and taste, but as soon as possible it should be administered 
in a nursing-bottle. The temperature should be about 96° Fahr. When 
the infant acquires a taste for the preparation, it may be given ad libi- 
tum twice a day. 

Buttermilk-cure may be substituted for the milk-cure in cases of 
stomach disease, in which the former has proved so successful, and in 
cases of albuminuria and diabetes. In consequence of the large propor- 
tion of lactic acid which it contains, buttermilk is more especially indi- 
cated in diabetes. . 

Infant-Feeding. — It has already been stated that fresh milk of the 
cow is the best substitute for the mother's-milk. Some additional obser- 
vations as to the management of cow's-milk, and as to the substitutes 
therefor, may, however, be necessary. There can be no doubt that cow's- 
milk is better than goats' or asses' as a rule, although there are infants 
who thrive on the two last-named better. In the large cities where it 
is impossible to procure fresh milk, condensed milk is an efficient sub- 
stitute. As in the preparation of this the temperature is raised to near 
the boiling-point of water, it undergoes no change, and can be used 
when fresh milk is not to be procured, or can not be preserved. Con- 
densed milk is ready for use by mixing it with water in the proportion 
of one teaspoonf ul of milk to seven of warm water. When the addition 
of lime-water is desirable, it can be added in proper proportion. In the 
author's experience, children, with few exceptions, do well on condensed 
milk. 



48 KESTORATIVE AGENTS. 

Casein is that constituent of milk which is most likely to disagree 
with infants. Dilution with water, lime-water, barley-water, etc., is 
not unfrequently effective in securing the digestion and absorption of 
the casein ; but some infants are unable to digest it at all. Various 
expedients are resorted to when the casein fails entirely of digestion. 
Cream diluted with barley-water sometimes succeeds extremely well. 
The indigestion of the casein of a given specimen of milk may be 
due to an insufficient quantity of cream ; this defect can be obviated 
by adding it artificially. When the infant is not nourished suffi- 
ciently, and yet does not pass undigested casein, the proportion of 
cream is probably too low. To assist the digestion of casein, Jacobi 
recommends that a little well-sweetened oatmeal-gruel be given the 
infant before taking the bottle, or be mixed with the milk. His 
method of preparing the food is as follows : 

" A teaspoonf ul of either oatmeal or barley is boiled in from three 
to six ounces of water, with some salt, for twelve or fifteen minutes, 
the decoction to be quite thin for very young infants, thicker for 
later months, and then strained through a linen cloth. Infants of 
four or six months are to have equal parts of this decoction, which 
ought to be made fresh for every meal ; and boiled and skimmed 
cow's-milk and sugar are to be added. At an early age, the thin de- 
coction ; at a later, the milk ought to prevail in the mixture, which 
ought to be given at a temperature of 80° to 90° ; ought to be neu- 
tralized, when acid, with a few grains of bicarbonate or carbonate 
of potassa or soda, and, until infants are eight or ten months old, thin 
enough to be taken through a nursing-bottle." 

Various substitutes have been proposed for cow's-milk ; but they 
are at best constructed on doubtful principles, and vary greatly in 
composition. Liebig's preparation has had the greatest celebrity, be- 
cause of the reputation of its inventor, rather than of its intrinsic 
merit. It is prepared as follows : An ounce of wheaten flour is mixed 
with ten ounces of milk ; it is then boiled for ten minutes, removed 
from the fire, and allowed to cool to 90° Fahr. An ounce of malt- 
powder containing fifteen grains of potassium bicarbonate, and two 
ounces of water, are then stirred into it, and the vessel, covered, 
stands for an hour and a half at a temperature of 100° Fahr. It is 
boiled for a few minutes again, and then strained, when it is ready 
for use. The object of the malt is to transform the starch into glu- 
cose. 

Chambers recommends the following when the artificial feeding of 
the infant begins : " Cow's-milk should at first be mixed with half its 
bulk of soft, pure, tepid water, in each pint of which has been sus- 
pended a drachm of sugar-of-milk, and two grains of phosphate of 
lime, finely powdered. If the milk has been partially skimmed, as is 
often the case in cities, then a tablespoonful of cream should be added 



ALIMENTATION IN DISEASES. 49 

to each pint." Smith, whose authority in questions of infant thera- 
peutics is admitted, also advises the addition of cream to ordinary 
cow's-milk, and carbonate of potassa or lime-water. At the expiration 
of six months the milk should be given undiluted. An infant's food 
should always be raised to the temperature of 95° Fahr. Regularity 
in the time of feeding is of very great importance : for the first six 
weeks, every two hours, and subsequently, every three hours. 

ALIMENTATION IN DISEASES. 

Aliment in Acute Inflammations and Fevers. — The febrile 
state induces serious changes in the constitution of solids and liquids. 
The interstitial fat disappears from the tissues, which become soft and 
watery. The muscles become flabby and pale, and decline in con- 
tractile energy. Digestion is feeble, or suspended or abnormal, and 
the food supplied is either rejected or enters the blood in an imper- 
fectly-prepared state. The blood suffers material alterations ; the red 
corpuscles diminish in number ; the fibrin increases, and the products 
of imperfect tissue-metamorphosis accumulate. The urine is usually 
scanty and high-colored, and loaded with uric acid and urates. The 
chlorides more or less diminish in or disappear from the urine, but 
accumulate in the inflamed tissues. The excretion of phosphates is 
increased. In the tissues, the seat of organic alterations, rapid but 
imperfect metamorphosis ensues, and on the one side pathological ma- 
terials crowd the interstices in the anatomical elements, and on the 
other the products of waste struggle for elimination. Avoiding fur- 
ther speculation as to the fever-process, it will suffice to state that an 
enormous increase of the urea-discharge takes place, and that the 
organs and tissues of the body undergo a granular disintegration, 
which has been designated " parenchymatous degeneration " ; or, as 
it may be stated, the increased temperature of fever represents an 
enormous consumption of the nitrogenous elements. The higher the 
range of temperature, as a rule, the more extensive the parenchyma- 
tous degeneration. 

In fevers and inflammations not of the digestive tract, the most 
useful aliments are milk and beef -tea. These should be given at in- 
tervals determined by their rate of digestibility, usually about every 
three hours. Fresh milk only should be used, and, if the stomach be 
irritable, it may be diluted with one half to one fourth of lime-water. 
It has been conclusively demonstrated that fresh milk is the most 
suitable aliment in typhoid, and it may be depended on wholly (John- 
son). It is equally applicable as the aliment in scarlatina, partly as a 
nutrient, and partly as a diuretic, for in this disease one of the chief 
dangers is from arrest of the urinary secretion. 

The author is convinced that beef-tea and beef-essence are too 
exclusively used in the treatment of the fevers and inflammatory dis- 



50 RESTORATIVE AGENTS. 

eases. As an aliment, beef -tea is much inferior to milk, and it is also 
more difficult of digestion. It is not unusual to see, in cases of typhoid, 
the beef -tea floating on the peculiar dejections of this disease. It 
ought, therefore, never to be used as the exclusive aliment in typhoid 
cases. Another fallacy of a very dangerous kind is current in do- 
mestic practice, viz., the belief that beef-tea, which gelatinizes on 
cooling, is especially rich in nutritive elements. Such beef -tea con- 
sists chiefly of gelatin, which has very little value as a nutrient. 

FORMULA FOR ANIMAL BROTHS. 

u Beef- Tea. — A pound of lean beef should be freed from fat, tendon, carti- 
lage, bone, and vessels; it must be chopped up fine, and put in a pint of cold 
water to digest for two hours. It should simmer on the range or stove for three 
hours, hut the temperature should not exceed 160° Fahr. The water lost by 
evaporation should he made up by the addition of cold water, so that a pint of 
beef-tea should represent one pound of beef. It should be strained, the beef 
being carefully expressed. A wineglassful every three hours is a suitable quan- 
tity for administration in ordinary acute cases. 

u Mutton- Broth. — Lean loin of mutton, one pound, exclusive of bone ; water, 
three pints. Boil very gently till tender, throwing in a little salt and onion ac- 
cording to taste. Pour out the broth into a basin, and, when it is cold, skim 
off all the fat. It can be warmed up as wanted. 

" ChicJcen-Broth. — Skin, and chop up small, a small chicken, or half a large 
fowl, and boil it, bones and all, with a blade of mace, a sprig of parsley, and a 
crust of bread, in a quart of water, for an hour, skimming it from time to time. 
Strain it through a coarse colander." 

The digestibility of these animal broths is improved by the addi- 
tion of pepsin and muriatic or lactic acids. Beef-essence, obtained by 
pounding finely-divided beef in a mortar until the nutritive elements 
are separated from the fiber, may be administered instead of the 
broths above described. Essence of this kind may be mixed with 
sherry or other wines, whisky, or brandy, provided alcoholic stimu- 
lants be also indicated. The meat solution which Leube employs so 
successfully in the treatment of gastric ulcer and other stomach-dis- 
eases, is prepared by digesting meat, with muriatic acid and pepsin, in 
air-tight vessels, at a high temperature. By this process the meat is 
converted into peptones, ready for absorption. 

FORMULAE FOR DIET-DRINKS. 

" Wine- Whey. — Put two pints of new milk in a saucepan, and stir it over a 
clear fire till it is nearly boiling ; then add a gill of sherry, and simmer it for a 
quarter of an hour, skimming off the curd as it rises. Then add a tablespoonful 
more sherry, and skim again for a few minutes. 

" Flaxseed- Tea. — Flaxseed, whole, one ounce; white sugar, one ounce; 
liquorice-root, half an ounce ; lemon-juice, four tablespoonfuls. Pour on these 
materials two pints of boiling water ; let them stand in a hot place four hours, 
and then strain off the liquor. 



ALIMENTATION IN DISEASES. 51 

u Barley -Water. — Wash two ounces of pearl-barley with cold water. Then 
boil it for five minutes in some fresh water, and throw both waters away. Then 
pour on two quarts of boiling water, and boil it down to a quart. Flavor with 
thiuly-cut lemon-rind, and sugar to the taste ; but do not strain unless at the 
patient's request." 

Other foods frequently prescribed for the inflammatory and febrile states are 
wine-whey and " eggnog," or " egg-flip." To a pint of boiling milk add four 
ounces of sherry ; strain and sweeten the whey to the taste. This is a grateful 
subacid drink, but slightly nutritive. Eggnog may be prepared as follows : 
"Scald some new milk by putting it, contained in a jug, into a saucepan of boil- 
ing water, out it must not oe allowed to toil. When quite cold, beat up a fresh 
egg with a fork in a tumbler with some sugar ; beat quite to a froth, add a des- 
sert-spoonful of brandy, and fill up the tumbler with scalded milk." This may 
be used in alternation with beef-tea, or exclusively in acute inflammatory or 
febrile affections, but its administration should not usually be more often than 
every three hours. Milk and egg may be served separately with wine or brandy, 
as follows: "To one tablespoonful of brandy, or one wineglassful of sherry, in 
a bowl or cup, add powdered sugar and a very little nutmeg to taste. Warm a 
breakfast-cup full of new milk and pour it into a spouted jug. Pour the con- 
tents from a height over the sugar, wine, etc. The milk must not ooiV 

" Beat up with a fork an egg till it froths ; add a lump of sugar and two 
tablespoonfuls of water ; mix well, pour in a wineglass of sherry, and serve be- 
fore it gets flat. Half the quantity of brandy may be used instead of sherry." 

The foregoing are the most accessible and the most nutritious ali- 
ments for the acute stage of fevers and inflammations. They contain 
the materials necessary to supply the loss taking place in the organism 
at large, and to repair the damage to tissues in the state of inflam- 
mation. 

Aliments in Diseases of the Digestive Organs. — In acute and 
chronic affections of the digestive organs, especially the latter, the 
skim-milk treatment, already described, possesses the highest value. 
When the trouble is localized to the stomach and is of an acute char- 
acter, only the most easily-digested aliments are borne, as, for ex- 
ample, milk and lime-water, barley-water, tamarind-whey, carbonic- 
acid water, effervescent lemonade, etc. The following formulae are 
useful : 

" To a tablespoonful of pearl-barley, washed in cold water, add two or three 
lumps of sugar, the rind of one lemon, and the juice of half a lemon. On these 
pour a quart of boiling water and let it stand for seven or eight hours. Strain 
it." 

"Boil an ounce of tamarind-pulp with a pint of milk, and strain." 
" Squeeze two large lemons, and add a pint of spring or cistern water to the 
juice and three or four lumps of white sugar. When required for use, pour half 
of it into a tumbler, and add half a small teaspoonful of bicarbonate of soda ; 
stir and drink while effervescing." 

In the chronic affections of the stomach, when digestion is feeble, 
especially of the nitrogenous elements (deficiency of gastric juice), 



52 RESTORATIVE AGENTS. 

such aliments as boiled rice, tapioca, arrow-root, unferinented bread 
(aerated bread), and the farinaceous vegetables, are indicated, for 
these foods are digested chiefly in the small intestine. Cases of acid- 
ity and heart-burn, dependent on the fermentation of the starchy and 
fatty elements of the food, require abstinence from the articles con- 
taining them. The acid fruits and vegetables (apples, peaches, toma- 
toes, etc.) are to be preferred under such circumstances to the farina- 
ceous foods. An acid wine (Rhenish or Catawba), taken at the 
principal meal, will often correct the acidity derived from the fermen- 
tation of starch and fat. 

In intestinal indigestion, summer diarrhoea, and cholera infantum, 
it is necessary to supply those foods which undergo solution in the 
stomach, in compliance with the fundamental therapeutical principle 
of giving a suffering organ (the intestine) rest. Starches and fats 
should therefore be withheld. Bread, arrow-root, potato, beans, peas, 
butter, and other fats, increase the disease, because on reaching the 
affected organ they are not finally digested, but act as irritants. This 
result is well seen in the summer diarrhoea of infants. Milk, eggs, 
animal broths, broiled or raw beefsteak, oysters, white-fish, are suita- 
ble aliments under these circumstances. Similar rules obtain in the 
treatment of jaundice from catarrh of the gall-ducts and of biliary 
concretions. The starches and fats are especially active in setting up 
those local disturbances which result in the production of jaundice by 
extension of the catarrhal process from the duodenum along the he- 
patic duct. The use of fat and oil has an immediate result in favor- 
ing the crystallization of the cholesterin, or in causing inspissation 
of the bile. 

Cases of chronic diarrhoea are sometimes remarkably benefited by 
a diet of grape-juice, peaches, and such succulent vegetables as tomato, 
celery, and raw cabbage. It is probable that the cases so benefited 
are really scorbutic in character. The author has known many obsti- 
nate cases of summer diarrhoea of infants to be improved by the ad- 
dition of ripe peaches to the milk-diet. 

A proper regulation of the diet is of great importance in the treat- 
ment of habitual constipation. This usually depends on deficient se- 
cretion, or torpor (a paretic state) of the muscular layer of the intes- 
tines. Corn-bread, cracked wheat, oatmeal, bread of unbolted flour, 
fruits, and such vegetables as green corn, tomatoes, and celery, are in- 
dicated. Those troubled with habitual constipation, to a moderate 
extent, may overcome it by the daily use at dessert of a few almonds 
and raisins, about six of each. Haemorrhoids due to congestion of the 
portal vein, or to constipation, are much benefited by the grape-cure, 
or a diet of fruits and succulent vegetables. 

Aliment in Cachectic States. — To store up fat in the tissues and 
to increase muscular power, the diet must consist of both nitrogenous 



ALIMENTATION IN DISEASES. 53 

and carbonaceous elements. The fats themselves hold the first place 
as fat-forming foods. Those most frequently employed for this pur- 
pose are the fat of meat, butter, olive-oil, cream, and milk. Sugar 
and saccharine fruits and vegetables rank next in importance as fat- 
formers. The organism has the power of transforming starch into 
fat, whence bread, potato, pastry, rice, arrow-root, etc., belong to this 
class. The malt liquors undoubtedly possess an extraordinary energy 
in the same direction, hence the use of beer and ale by nursing women ; 
but it is undoubtedly true that milk is better for increasing the pro- 
duction of milk. Less force is lost in the conversion of cow's milk 
into human milk than in the complex process needed for transforming 
the nutritive elements of malt liquor. The same fact is true in regard 
to the relative facility of the appropriation of fatty aliment and of 
the conversion of saccharine and farinaceous food into fat. It is also 
true that, for the increase of muscular power, muscular tissues and 
juices are more easily applied by the organism. 

In the scrofulous, mercurial, plumbic, syphilitic, and paludal ca- 
chexia?, and in phthisis, a combination of the flesh and fat forming 
foods is necessary. The hunger or denutrition cure, as already ex- 
plained, may be applied to the treatment of these cachexia?, the object 
being to produce such waste and molecular changes as to cause the 
elimination of the morbific matters. On the other hand, the object 
sought to be accomplished in these states of disease and in phthisis, 
by improving the body nutrition, is to supplant by fresh material the 
lesions of the anatomical elements. 

In rickets (mollities ossium) it is necessary to supply a food rich in 
phosphate of lime and other phosphate salts. Oatmeal, bread of un- 
bolted flour, cracked wheat, etc., should be added to the dietary. 

Gout, rheumatism, and the so-called uric-acid diathesis, require a 
diet composed chiefly of farinaceous vegetables and acid fruits. Animal 
food and saccharine substances are contraindicated in these disorders. 

In no disease is the influence of diet more conspicuous for good or 
evil than in diabetes. I have already alluded to the milk-cure, revived 
by the Montpellier school and popularized in England by Dr. Donkin. 
All saccharine substances and fruits and vegetables containing them, 
and all farinaceous foods the starch of which is easily convertible into 
dextrine and sugar, are injurious in diabetes. In this prohibition are 
included bread, potato, beets, beans, peas, sugar, milk, pastry, and 
sweetmeats of all kinds. Tomatoes, celery, and raw cabbage, are not 
objectionable. In order to compensate for the loss of bread, the great- 
est deprivation endured by these diabetics, gluten and almond bread 
are now prepared. To supply the deficiency in the alimentation of 
diabetics caused by the withdrawal of the starch elements of the 
food, fats must be used, as butter, olive and cod-liver oil, fat of meat, 
cream, etc. 



54 RESTORATIVE AGENTS. 

FORMULA FOR VARIOUS ARTICLES OF DIET. 

Lemonade. — " Put the juice of a lemon to a pint of water, in which an ounce 
of sugar has heen dissolved ; then add the white of an egg and froth it up. It 
may he iced." 

Farina- Gruel. — " Stir two tahlespoonfuls of farina into a quart of water in 
a milk saucepan ; let this boil until it has grown quite thick ; add a pint of milk, 
a little salt, and let it boil fifteen minutes longer ; turn out into a bowl, and 
sweeten to taste." 

Oatmeal- Gruel. — "Put a pint of boiling water into a saucepan; into this 
stir a couple of tahlespoonfuls of oatmeal until quite smooth ; let this boil well 
for ten or fifteen minutes, season with salt, then strain through a strainer, and 
add a little port wine and sugar, if the patient may have it." 

Corn-Meal Milk-Gruel. — "Sweeten a quart of milk, and stir in two table- 
spoonfuls of corn-meal. This must be carefully cooked, as the meal is apt to 
scorch, and must be stirred while cooking. A little nutmeg grated on top after 
it is done makes a pleasant flavor. If the gruel is desired thick, more meal will 
be needed." 

Tapioca Jelly. — " One cup of best tapioca put to soak with a pint of cold 
water ; when soft put in a saucepan with one cup of sugar, the rind and juice 
of one lemon, a little salt, one pint more water ; stir until it boils ; turn into a 
mold ; set to cool ; add one glass of wine if desired." 

Sago. — " Put half an ounce of sago into an enameled saucepan with three 
quarters of a pint of cold water, and boil gently for an hour and a quarter. 
Skim when it comes to a boil, and stir frequently. Sweeten with a dessert- 
spoonful of sifted loaf-sugar. If wine be ordered, two dessert-spoonfuls; and, 
if brandy, one dessert-spoonful." 

Arrow-root. — " Mix two teaspoonfuls of the best arrow-root with half a 
wineglassful of cold water ; add a pint of boiling water ; put it into an enam- 
eled saucepan, and stir over the fire for three minutes. Sweeten with three tea- 
spoonfuls of sifted loaf-sugar. Add either a wineglassful of white wine, or a 
tablespoonful of brandy, if permitted." 

Arrow-root Milk. — " Mix two teaspoonfuls of arrow-root with a wineglassful 
of new milk ; add half a pint of boiling milk ; put it into an enameled saucepan, 
and stir over the fire for three minutes. Sweeten with a dessert-spoonful of 
sifted loaf-sugar." 

Whipped Cream. — " Beat half a pint of fresh double cream with a whisk, add 
a dessert-spoonful of very finely powdered loaf-sugar, and twenty drops of es- 
sence of vanilla or any other flavoring ; when firm it is ready for use, but much 
improved by being on the ice for an hour or two." 

Corn-Starch Pudding. — " One quart of milk, four tablespoonfuls of corn- 
starch, four eggs, one tablespoonful of butter, six tablespoonfuls of sugar. Dis- 
solve the corn-starch in a little cold milk, and, having heated the rest of the 
milk to boiling, stir this in and boil three minutes, stirring all the time. Take 
from the fire, and while still hot put in the butter. Set away until cold. Beat 
the eggs very light, whites and yolks separately. Stir the sugar and any flavor- 
ing desired in the yolks and then add the beaten whites, and stir in the corn- 
starch, beating thoroughly to a smooth custard. Turn into a buttered dish and 
bake half an hour. To be eaten cold." 

Beef-Juice. — "Broil quickly some pieces of round or sirloin, of a size to fit 
in the cavity of a lemon-squeezer. Both sides of the beef should be quickly 



ALIMENTATION IN DISEASES. 55 

scorched to prevent the escape of the juices, but the interior should not be fully 
cooked. As soon as ready, the pieces should be pressed in the lemon-squeezer, 
previously heated by being dipped in hot water. The juice, as it flows away, 
should be received into a hot wineglass, and, after being seasoned to the taste 
with salt and a little Cayenne pepper, eaten while hot. If preferred, the juice 
may be frozen." 

Meat-Tea. — "Put one pound each of beef, mutton, and veal, cut into small 
pieces, into three pints of cold water. It should simmer for three or four hours, 
but not boil. When finished, the tea should be carefully strained, and seasoned 
with salt, and Cayenne pepper if preferred." 

Cream- Soup. — " Take one quart of good stock (mntton or veal), cut one 
onion into quarters, slice three potatoes very thin, and put them into the stock 
with a small piece of mace ; boil gently for an hour ; then strain out the onion 
and mace ; the potatoes should, by this time, have dissolved in the stock. Add 
one pint of milk, mixed with a very little corn-flour to make it about as thick as 
cream. A little butter improves it. This soup may be made with milk instead 
of stock, if a little cream is used." 

Oatmeal- Soup. — " Put two ounces of oatmeal in a basin, pour over it a pint 
of cold water, stir it, and let it stand a minute ; then pour over it, quickly stir- 
ring all the time, a pint of good broth, pour through a fine strainer into a sauce- 
pan, taking care that none of the coarse part of the meal goes into the soup. 
Boil the soup for ten minutes, season and serve." 

ARTIFICIAL DIGESTION. 

We owe to Dr. Roberts, of Manchester, the introduction of partly- 
digested foods, under the term "peptonized." The formulae below 
show the manner in which they are prepared. The liquor pancreati- 
cus mentioned is a solution of the pancreatic juice. This differs from 
the stomach- juice in that it requires an alkali to give it activity. It 
can now be obtained of the pharmaceutists or druggists. 

Peptonized Mill.—" Fresh milk is diluted with water in the proportion of 
three parts of milk to one part of water. A pint of this mixture is heated to 
boiling, and then poured into a covered jug. When it has cooled down to about 
140° Fahr., one or two teaspoonfuls of the liquor pancreaticus, and a small pinch 
of bicarbonate of soda (in solution), are mixed therewith. The jug is then 
placed under a ' cozy ' in a warm situation for one hour. At the end of this 
time the product is again boiled for a couple of minutes. It can then be used 
like ordinary milk." 

Peptonized Milk- Gruel.—" Half a pint of well-boiled gruel is added, while still 
boiling hot, to half a pint of cold milk in a covered jug. The mixture will have 
a temperature of about 125° Fahr. The liquor pancreaticus and the bicarbonate 
of soda are then added in the same proportion as in the preceding process. 
The jug is placed under a ' cozy ' and kept warm for an hour and a half. The 
contents are then boiled for a couple of minutes, and the product is ready for 
use. By this second method the use of the thermometer is dispensed with." 

Nutrient Enemata. — It not unfrequently happens that the stom- 
ach will not receive and dispose of nutrient materials, when it becomes 



56 RESTORATIVE AGENTS. 

necessary to employ nutrient rectal injections. It has been proposed 
to treat ulcer of the stomach by absolute rest of the organ, and the 
introduction of foods by the rectum. In cases of excessive irritabil- 
ity of the stomach the same practice is sometimes necessary. (Eso- 
phagotomy and yastrotomy, as also wounds of the stomach, may ren- 
der the use of nutrient enemata indispensable to save life. It should 
not be forgotten that the rectum is not an organ of digestion ; hence 
nutrient enemata must contain the materials for artificial digestion. 
Furthermore, the mucus and fluids of the rectum are alkaline in reac- 
tion. To secure rapid osmosis, therefore, the enemata should have an 
acid reaction. The following formula is suitable for the purpose : 

Beef -tea, prepared as before described, four ounces ; hydrochloric 
acid, ten minims ; glycerole of pepsin (Scheffer's), two drachms. 

If the rectum is irritable, ten to twenty drops of the tincture of 
opium may be added to the injection. If stimulants are indicated, 
brandy may also be added. The rectum soon becomes intolerant of 
injections ; hence, the greatest care should be used in practicing them, 
to avoid sudden distention of the bowel, and frequent introduction of 
nutrient materials should be avoided. Five times in the twenty-four 
hours should be the maximum — for artificial digestion is much slower 
than normal stomach digestion. 

Leube recommends the following as a nutrient injection : " Take 
about five ounces of finely-scraped meat ; chop it still finer, add to it 
one and a half ounce of finely-chopped pancreas free from fat, then 
add about three ounces of lukewarm water, and stir to the consistence 
of a thick pulp." 

Or the following peptonized formula may be used : " A nutritive 
enema should be prepared in the usual way — of milk — or of milk with 
beef -tea or eggs — or of milk-gruel. To half a pint of the warm enema 
a tablespoonful of the liquor pancreaticus and thirty grains of bicar- 
bonate of soda should be added. The enema can then be administered 
at once." 

Supplementary Rectal Alimentation. — Under this designation, Dr. 
A. H. Smith, of New York, describes a method of rectal alimentation 
with defibrinated blood, which seems in a high degree useful. He 
ascertained that " three to four ounces of blood administered at night 
would be so completely absorbed in the course of eight or ten hours 
that no trace of it could be found in the morning evacuation." To re- 
tain the blood fluid, it must be defibrinated at the moment it is drawn, 
which may be done by stirring it with a bundle of twigs as it flows 
away. In chronic cases three to six ounces may be thrown into the 
rectum morning and evening ; in acute cases every two to three hours. 
It may be used cold, but it is better to raise it to the temperature of 
the rectum. Constipation usually results, and in some instances the 
body exhales a rather fetid odor, and the stools are offensive. Another 



BEVERAGES. 57 

gle objection may be urged against this method : sometimes a foul- 
smelling and tenacious material coats the surface of the mucous mem- 
brane and prevents absorption. For this reason, and to promote a 
favorable disposition of the blood, the bowel should be irrigated with 
water once or twice a week to clear away any retained or adherent 
matters. If the rectum is irritable, a little laudanum may be added 
to each blood-enema. 

BEVERAGES. 

Coffee. — The seed of Caffea Arabica ; cafe, Fr. ; Kajfee, Ger. 

Composition. — Coffee contains an alkaloid — caffeine — which is 
nearly, if not quite, identical with theine, a principle found in tea ; a 
volatile oil ; a form of tannic acid ; sugar, gum, etc. The tannic acid 
is that variety known as caffeo-tannic, or caffeic. 

The peculiar odor and flavor of roasted coffee are due to the caffeic 
acid, which is, in part, converted into methylamine ; to the aromatic 
oil ; doubtless, also, to the sugar, which is changed into caramel. 

Peepaeations. — Coffee is never used in the raw state as a bever- 
age. After roasting, it is made into an infusion or decoction. An 
infusion made at a low temperature, which should not exceed 200° 
Fahr., is better than a decoction. If the heat be too great, those aro- 
matic constituents which impart to coffee its special aroma, are dissi- 
pated. Coffee is now usually prepared by the process of percolation. 
The best product is obtained by steeping the coffee for some time in 
hot water. Coffee can be " settled," or clarified, by the addition of 
some white of egg, or isinglass, or by pouring on from a height some 
cold water. 

Tea. — The dried leaves of Camellia Thea ; th'e, Fr. ; Thee, Ger. 

Composition. — The constituents of tea are very much the same as 
those of coffee : theine ; an aromatic oil ; sugar and gum, and a pe- 
culiar form of tannic acid. 

Peepaeatioxs. — Tea is only used in the form of infusion. The 
character and quality of the beverage vary greatly with the kind of 
tea used in the preparation of the infusion. It will suffice to state that 
green tea is more astringent than the other varieties, partly because it 
contains more tannin, and partly because it is sophisticated to adapt it 
to a peculiar taste. 

Cocoa. — Obtained from the seeds of Theobroma Cacao ; cocoa, 
Fr. ; Kakao, Ger. 

Composition. — The active principle is theobromine, a substance 
which resembles the alkaloids of coffee and tea, except that it contains 
more nitrogen than theine and caffeine. Another important difference 
between cacao and coffee and tea is the large amount of a peculiar fat 
(cacao-butter) contained in cocoa. There is also present a minute quan- 
tity of a volatile oil, on which depends in part the characteristic aroma. 



58 RESTORATIVE AGENTS. 

Actions and Uses. — The use of coffee and tea, or of a correspond- 
ing beverage, is almost universal among civilized nations. This fact 
is supposed to indicate that a need exists in the human constitution 
which these beverages supply. Such a view is hardly tenable, the 
highest physical and mental activity not being incompatible with 
entire abstinence from them. Under some circumstances, however, 
they are peculiarly grateful ; for example, to remove the sense of 
fatigue and hunger, and to allay the mental unrest produced by fa- 
tigue and anxiety. 

Coffee has a somewhat laxative action on most persons ; on the 
other hand, tea has astringent properties — especially that variety 
known as green tea. It has been affirmed and denied that coffee and 
tea lessen the rate of tissue metamorphosis, and consequently the ex- 
cretion of urea. If these beverages check waste, they may be consid- 
ered as indirect nutrients. If used to excess as beverages, they derange 
the organs of digestion and excite functional disturbances of the nerv- 
ous system — on the part of the digestive organs : acidity, flatulence, 
pyrosis, eructations, etc. ; on the part of the nervous system : head- 
ache, vertigo, tinnitus aurium, and confusion of mind. The evil results 
of habitual excess are best seen in sewing-women addicted to tea-tip- 
pling. It is not uncommon for these women to live upon tea and bread 
for long periods, resulting in their becoming excessively nervous and 
dyspeptic. The mucus of the stomach plays the part of a ferment ; 
the bread undergoes the acetic fermentation, and this process is facili- 
tated by the presence of a quantity of a weak astringent solution. 
Disorders of digestion due to this cause can be removed by withdrawal 
of the offending beverage. It is not less true that the after-dinner cup 
of coffee not unfrequently assists the digestion of a too elaborate din- 
ner. Those accustomed to the morning cup of coffee are apt to suffer 
from headache if deprived of their usual beverage, partly because it 
hastens the intestinal movements and assists the morning evacuation, 
and partly because it favors the stomach digestion if not taken in 
excess. 

A cup of strong coffee taken in the early morning is held to be 
prophylactic against malarial infection. Coffee produces wakefulness, 
and opposes opium narcosis ; hence strong black coffee is one of the 
means resorted to in the treatment of opium-poisoning. 

Cocoa, as already set forth, is more directly nutritious than coffee 
or tea, and, as it is rich in fatty matters, is much more difficult of di- 
gestion, so that many dyspeptics can not use it at all. Cocoa is the 
most useful beverage in those conditions of the system requiring nu- 
tritious aliment, especially in phthisis and similar wasting diseases, 
and should constitute a part of the diet in these maladies unless it 
disagrees. 

Caffeine as a remedy will be considered in its appropriate place. 



BEVERAGES. 59 

Milk. — Regarded from all points of view, milk is the most impor- 
tant beverage. Enough has been said on the subject of milk as a food 
for invalids ; but something additional may be necessary on its die- 
tetic position as an ordinary beverage. 

When coffee, tea, and cocoa disagree, milk may be adopted as the 
ordinary beverage, and usually with great advantage. For breakfast 
it may be drunk warm. Large draughts of iced milk, according to 
the American custom, are injurious when drunk at meals ; its tem- 
perature should not be lower than 60° Fahr. If a sense of weight 
and uneasiness follow its use, it will be better borne if diluted one 
fourth to one half with lime-water. If it be desired to improve its 
nutritive qualities, cream to one fourth or to one half may be added. 
In the indigestion of the obese, or in the case of those who suffer from 
hepatic disorders, the milk should be skimmed. A very valuable nu- 
trient, but which is, unfortunately, not very digestible, is chocolate 
made with milk and cream. Such an aliment is especially suited to 
invalids with wasting diseases, but who yet retain the power to digest 
fats. 

Some find it impossible to drink milk, because it induces " bilious- 
ness." In this case skimmed milk should be used. Generally the in- 
digestion called " biliousness " means errors of diet in other directions, 
so that regulation of the food suffices to prevent this form of indis- 
position. 

Authorities referred to in this section : 

Ballot. On the Food of Infants, etc., Medical Times and Gazette, vol. i, 1870, p. 
331. 

Banting. Letter on Corpulence, pamphlet. 

Bennet, Dr. James Henry. Nutrition in Health and Disease, second edition, Phila- 
delphia, Lindsay & Blakiston, 1876. 

Brinton. On Food. and Digestion, London, 1861, pp. 485. 

Chambers, Dr. Thomas King. A Manual of Diet in Health and Disease, Philadel- 
phia, Henry C. Lea, 1875. 

Ctr, Dr. Jules. Traite de Alimentation, Paris, 1869, pp. 575. 

Donkin, Dr. Arthur Scott. On a Purely Milk-Diet in the Treatment of Diabetes 
Mellitus, Brighfs Disease, Disease of the Supra-renal Capsules, Fatty Degeneration, etc., 
Lancet, vol. ii, 1869, and vol. i, 1870. 

Flint, Dr. Austin, Jr. Physiology of Man, Alimentation, Digestion, Absorption, 
New York, 1867. 

Fonssagrives, J. B. Hygiene Alimcntaire, deuxteme edition, Paris, 1867, pp. 670. 

Jacobi, Dr. A. and Dr. Mary Putnam. Infant Diet, New York, G. P. Putnam's 
Sons, 1876. 

Jones, Dr. Joseph. U. S. Sanitary Commission, Memoirs Medical, p. 469, ct scq. 

Letheby, Dr. H. On Food, second edition, New York, 1872, pp. 255. 

Lebert, Dr. Hermann. Ucber Milch- und Molkcn-Kuren, Berlin, 1869. 

Ibid. TJie Medical Times and Gazette, vol. ii, 1870, pp. 201. 

Mitchell, Dr. S. Weir. On the Use of Skimmed Milk as an Exclusive Diet in Dis- 
ease, Philadelphia Medical Times. 

Nothnagel, Dr. Hermann. Handbuch der Arzneimittellchre, Berlin, 1870, p. 676. 



60 RESTORATIVE AGENTS. 

Parkes, Dr. E. A. A Manual of Practical Hygiene, second edition, London, 1866, 
pp. 624. 

Pereira, Dr. Jonathan. A Treatise on Food and Diet, London, 1843, pp. 542. 

Richter, Dr. H. E. Bericlit uber Milch-, Molken-, und Kumys-Kuren, Schmidt's 
Jahrbucher der gcsammten Medicin, vol. cxlviii., p. 201. 

Smith, Dr. A. H. Archives of Medicine, New York, G. P. Putnam & Sons, 1879, 
Vol. I, No. 2, p. 113. 

Smith, Dr. Edward. Foods, New York, 1873 {International Scientific Series), pp. 
485. 

Tardieu. Dictionnaire d' Hygiene Publique, tome xi, Article " Lait" 

Trousseau. Clinique Medicate, vol. ii, p. 695. 

Water. — Aqua, water ; eau, Fr. ; Wasser, Ger. ; Aqua destillata, 
distilled water — water freed from its organic and inorganic impurities 
by distillation. This is alone official. 

Aqua Flumalis. — River-water. 

Aqua Fontana. — Well or spring water. 

Water as a remedial agent, when employed in internal maladies, 
and as a means of applying heat and cold externally, are the depart- 
ments of the subject coming within the scope of this article. 

Physiological Effects of Water — internal. — It need hardly 
be stated that water is an essential constituent of the tissues. 

A certain quantity of water or fluid aliment is necessary to the 
digestive process. An excessive quantity impairs digestion, by so far 
diluting the gastric juice as to render it incapable of dissolving the 
foods. Pepsin — the digestive ferment — is also weakened by too great 
fluidity of the stomach contents. The free use of cold drinks — ices 
and iced water — seriously disorders digestion by suspending the action 
of the pepsin, by diminishing the blood-supply needed by the stomach 
in its condition of functional activity, and no doubt also by depressing 
the nerves of the organs of digestion. To this state, induced by the 
free use of very cold drinks during meals, or during the time of di- 
gestion, has been applied the term " ice-water dyspepsia" a very com- 
mon malady in the United States. 

A glass of cold water in the morning before breakfast will in many 
persons cause a satisfactory evacuation of the bowels. The activity 
of the water is increased by the addition to it of a teaspoonful of 
common salt. 

Although water is essential to the constitution of the fluids and 
solids of the body, there is no doubt that large and frequent draughts 
of water may prove injurious by too great increase in the fluidity of 
the blood, and a consequent damage to the red corpuscles. 

The free use of water promotes nutritive changes, and causes in 
some subjects a decided increase in the formation and deposition of 
fat. The presence of water is essential, of course, to the metamor- 
phosis of tissue, whether physiological or pathological. The efficacy 
of mineral waters is in part due to the quantity of water taken, besides 



HYDROTHERAPY. 61 

the mineral constituents. Water may be taken with the view to cause 
increased excretion of certain substances. As a large part of that 
taken passes out by the kidneys, the functional activity of these organs 
is promoted by free drinking. With the water also passes out an in- 
creased amount of urea, chloride of sodium, and phosphoric acid, the 
product of the more rapid tissue-changes which ensue. The increased 
elimination of chloride of sodium does not continue, however. 

Water is also excreted by the skin, and free water-drinking pro- 
motes the cutaneous transpiration, especially when its action is aided 
by external warmth. The vapor of water also passes out abundantly 
in the breath. 

Physiological Effects of Water — external. — The influence of 
temperature must necessarily be considered in connection with the ef- 
fects of water when applied externally. 

Effects of Cold Water. — When an extremity — for example, the 
hand — is immersed in cold water, the temperature of the other hand 
also falls. Cold water abstracts the heat of the body, at least of its 
superficial surface, and affects the condition of the internal organs 
through the nervous system. It is through an influence transmitted 
from the peripheral distribution of the nerves of the hand to the cen- 
ter, and thence reflected to corresponding anatomical nervous connec- 
tions on the other side, that the fall of temperature in the one hand 
is due when the other hand is immersed in water. We have a right to 
assume, therefore, that, when cold water is applied to the whole sur- 
face of the body, changes of temperature take place within. Indeed, 
it has been shown experimentally by Brown-Sequard, that ice applied 
to the lumbar region causes a contraction of the arterioles of the kid- 
neys, and consequent diminished blood-supply to these organs. 

When a cold bath is entered, a marked sense of chilliness is expe- 
rienced, the skin becomes pale and is roughened by the erection of the 
hair-follicles {cutis anserina), the lips are blue, the breath has a spas- 
modic and catching character, and the pulse is quickened. The tem- 
perature of the surface is lowered, for the blood accumulates in internal 
organs, and the nerves of the skin are depressed. To the change in 
the conditions of the blood-supply, and the impression of the cold on 
the peripheral expansion of the nervous system, are due the coldness 
of the surface, the sobbing respiration, and the feeling of discomfort 
and depression. If the temperature of the water be not too low, and 
if the bodily vigor be sufficient to withstand the shock, the condition 
known as " reaction " speedily ensues. The coldness and depression 
are succeeded by warmth and a feeling of exhilaration ; the pulse 
quickens, and the respiration becomes easy and unembarrassed ; and 
the muscular strength is increased. If, however, the body be immersed 
for too long a period, the condition of reaction is supplanted by cold- 
ness, depression, weakened pulse, and muscular debility. This result 



62 RESTORATIVE AGENTS. 

is largely due to the continuous abstraction of heat, to the accumula- 
tion of blood in the great venous trunks, and the consequent interfer- 
ence with the metamorphosis of tissue. If healthy reaction comes on 
after bathing, the effects are those to which we apply the term tonic. 
The circulation is invigorated, tissue-changes take place more rapidly, 
and the products of increased tissue-metamorphosis are found in the 
urine. With the increased activity of the function of assimilation, 
the appetite and digestive power are improved, and the body gains in 
weight. 

Effects of Warm Water. — The degree of effect which is pro- 
duced by the immersion of the body in warm water is influenced by 
the temperature ; but the quality of the effect is the same at all de- 
grees from tepid to hot. The sense of warmth is at first grateful to 
the feelings ; the skin becomes red from the increased activity of its 
vessels ; the pulse quickens in beats, but diminishes in tension ; the 
respiration is more frequent ; precordial oppression is experienced ; 
an unpleasant sense of distention is felt in the head, and giddiness, 
faintness, and muscular languor, finally, are produced, if immersion be 
prolonged or the temperature be too high. The pulmonary and cutane- 
ous transpiration are increased by the warm bath ; the temperature of 
the body rises, and a condition is established by a hot bath, similar to 
the febrile state. Rapid disintegration of tissue ensues, the waste 
products escape chiefly by the skin and pulmonary mucous membrane, 
and decided loss of weight results. 

Modes of applying Water. — The water of a cold bath should 
have a temperature of 40° to 60° Fahr. If employed for its tonic 
action, the patient should not remain in it longer than the period of 
complete reaction. The tepid bath has a temperature of from 85° to 
95°, the warm bath from 95° to 100° Fahr., and the hot bath from 
100° to 106° Fahr. The duration of the stay in these w T ill depend on 
the purpose to be accomplished, whether mere excitation of the circu- 
lation in the skin, diaphoresis, or muscular relaxation. In directing 
the warm and hot baths, it should not be forgotten that a diseased 
state of the cerebral arteries is a contraindication to their use. 

The vapor of water in the form of the Russian bath, steam-bath, or 
warm or hot icet-pucking, may be used to accomplish the same objects 
as those obtained by the warm or hot bath. Without entering unduly 
into the details, it will suffice to state that the Russian bath consists 
in the exposure of the body in suitable apartments to the vapor of hot 
water, at a temperature gradually increased from 95° to 110° Fahr. 
The bath should not, under ordinary circumstances, exceed fifteen 
minutes in duration. In order to overcome the relaxing and debili- 
tating effects of the bath, the patient should either enter a cold bath 
or have cold water dashed over his body. This expedient, conjoined 
with friction of the surface, increases materially the good effects of 



HYDROTHERAPY. 63 

the Russian bath. In the absence of special arrangements for giving 
the Russian bath, simple means will suffice. The patient may sit 
upon a low stool with a blanket pinned about his neck, and under this 
the vapor of water may be conducted. Or, if confined to bed, the 
patient may be placed on a gum-cloth, and the blanket may be ele- 
vated above him by hoops, arranged transversely, under which the 
vapor of water may be conveyed from an ordinary tea-kettle. Fresh 
lime is sometimes used to generate hot vapor. The patient is placed 
on a low stool and surrounded by a blanket. Some pieces of freshly 
turned lime are then dropped into a vessel of water placed under the 
blanket, The slacking of the lime causes great heat, and the conse- 
quent generation of a considerable quantity of watery vapor, which 
also carries up with it minute particles of lime. This proceeding is 
said to be especially efficacious in membranous croup and diphtheria. 

Enveloping the body in cloths wrung out in hot water, or wrapping 
in a sheet which has been wrung out in hot water, and then covering 
with blankets, is a mode of applying moist heat which may be advan- 
tageously used. To various parts of the body, under the designation 
of " fomentations," warm and hot water applications are constantly 
used in domestic practice. 

The Wet-Pack. — This efficient means of producing the good effects 
of cold-water applications consists in wrapping the body in a linen 
sheet wrung out in cold water. The appliances are these : An ordi- 
nary single bedstead ; a hard mattress covered with several thicknesses 
of blankets or comforters ; a linen sheet. The sheet is dipped in cold 
water, and, when thoroughly wrung out, is laid smoothly on the bed. 
The patient reclines on the sheet, his head supported by a pillow. One 
side of the sheet at a time is then drawn over the patient's body and 
neatly tucked under the opposite side, the feet and legs being lifted 
up and the sheet made to entirely envelop them. Some blankets or 
comforters are now closely applied around the body of the patient. 
There is at first experienced a disagreeable sense of chilliness and dis- 
comfort, which is soon succeeded by a delightful glow. When reac- 
tion is fully established, the wet-pack should be removed, and the 
body be well rubbed with dry towels. The duration of this applica- 
tion should be from fifteen minutes to an hour. When active dia- 
phoresis is the object to be accomplished, the patient must be well 
enveloped in blankets, and continue in the bath for the longest period 
mentioned above. 

Tlie Rubbing Wet-Pac7c. — This is a convenient mode of taking the 
morning bath as a hygienic measure, and also of procuring more 
speedily some of the good effects of the wet-pack as applied above. 
It consists in enveloping the body with a sheet dipped in cold water, 
and rubbing vigorously with the sheet to induce reaction quickly. 
The patient stands up during the application, and an attendant rubs 



64 RESTORATIVE AGENTS. 

those parts inaccessible to the patient. When the sheet is removed 
the skin is dried by the vigorous application of coarse towels, and the 
patient immediately puts on his clothing. 

When it is not advisable to apply the wet-pack to the whole body, 
or when local diseases require limited application of the wet-pack, the 
sheet may be wrapped around the trunk only, or be confined to the 
region of the affected organ. In cases of extreme debility, or in very 
susceptible persons, the sheet may for the first applications be wrung 
out in tepid water, and subsequently the temperature of the water be 
lowered to that of the air (40° to 70° Fahr.). 

The Douche. — This consists in the impact against the body of a 
column of water from a height. No greater height than ten feet, and 
a column not larger than four inches, will be proper or safe under any 
circumstances. A hose attached to a water-pipe, the supply being 
regulated by a stopcock, is a convenient mode of using the douche. 
In domestic practice a large pitcher or water-bucket, if provided with 
a suitable spout, may be utilized for this purpose. The douche may 
be either cold, tepid, or hot ; it may have a direction descending, as- 
cending, vertical, horizontal, or oblique ; and the effect may be regu- 
lated by the height from which the water is projected, the size of the 
stream, and the force with which it is thrown against the part. As 
the effect of the douche is very great when the water is cold, when 
the volume of the stream is large, and when it is thrown with force, it 
is obvious that care must be used in directing it against the head, the 
chest, and the abdomen. As a rule, it is too violent a measure to be 
employed in weak and susceptible subjects about the trunk, but it 
may be used freely, of course, on the extremities. 

The Hip or Sitz Bath. — As regards temperature, this bath may be 
cold, tepid, warm, or hot, according to the indications requiring it. The 
apparatus for administering it consists of a tin or wooden tub of suffi- 
cient capacity to contain water enough to cover the hips and lower part 
of the abdomen when the patient sits down in it. The tub should have 
a raised back to support the patient, and should be sufficiently elevated 
above the floor, so that the feet may rest comfortably when the patient 
sits down in the water. In the absence of a special arrangement of 
this kind, any ordinary washing-tub will suffice. The duration of the 
hip or sitz bath will be from five to thirty minutes. 

Besides these, various local baths, cold, warm, or hot, under vari- 
ous designations, are used in medical practice, e. g., foot, hand, elbow, 
and head bath. The effects of these differ in no wise from the baths 
already described, except in degree. 

Therapy. — The applications of water in the treatment of disease 
are numerous and important. 

In tonsillitis, diphtheria, and croup, ice held in the mouth and al- 
lowed to come in contact with the fauces is extremely serviceable. The 



HYDROTHERAPY. 65 

wet-pack to the neck gives great relief in the same diseases. The mode 
of applying it is as follows : A napkin is wrung out in iced or cold 
water and wrapped around the neck ; and over this is put a dry towel 
or napkin to prevent evaporation, and also the wetting of the patient's 
clothes. In spasmodic croup (laryngismus stridulus) the application 
of iced water in this way will frequently very quickly stop the crow- 
ing inspiration and allay the distress of breathing. A cold douche 
will effect the same result, but this is an unnecessarily harsh remedy 
in these cases. Sometimes hot applications are more efficacious, when 
the napkin or towel may be wrung out in water as hot as can be borne. 
Cold affusion, or, better, sponging of the body with cold water, is an 
excellent means of preventing laryngismus stridulus when it arises 
from cold. 

Habitual constipation may sometimes be overcome by a glass of 
cold water taken before breakfast. Hcemorrhoids that bleed, espe- 
cially when attended by constipation, are improved by a daily rectal 
injection of cold water. When cold or warm water injections are used 
to cause an evacuation, it must be remembered that, usually in adults, 
a large amount of water is necessary — about one quart. A small 
quantity of iced water may be effective, for in this case the impression 
of the cold on the nerves of the rectum excites a reflex action of the 
whole intestinal canal. 

Pure water or distilled water is an effective diuretic, especially 
adapted to the relief of acute desquamative ?iephritis. The action con- 
sists in free discharge of the surplus water by the kidneys, and the 
consequent washing out of the tubules obstructed by the cast-off epi- 
thelium and tube-casts. Large draughts of water, as has already been 
stated, carry out from the kidneys the products of retrograde metamor- 
phosis, and hence the action is diuretic in the widest sense. The effi- 
ciency of many infusions, decoctions, and ptisans, employed in dropsies, 
is largely due to the amount of water ingested. The internal use of 
water in kidney-diseases may be supplemented by hot fomentations to 
the lumbar region. (See article Digitalis.) As irritation of the skin 
of the back has been shown experimentally to influence the caliber of 
the renal arterioles, there is sufficient warrant for the practice of ap- 
plying these fomentations to the lumbar region, when the functional 
activity of the kidneys is insufficient. 

When renal disease is so far advanced that the elimination of urea 
is seriously hindered, and stupor, somnolence, muscular twitching s, and 
even convulsions occur, great relief is obtained by exciting free action 
of the skin by means of the vapor-bath or hot wet-pack, the patient 
being well enveloped in blankets to favor powerful diaphoresis. The 
Turkish bath is very serviceable to restore the suppleness of joints 
and muscles after an attack of acute rheumatism, and chronic mus- 
cular rheumatism is benefited by the same means. No permanent 
5 



66 RESTORATIVE AGENTS. 

good result can be expected from these baths in chronic rheumatic 
arthritis. 

As a means of causing elimination of mineral poisons, baths are 
useful. Lead, mercurial, and paludal cachexia?, are relieved by the 
Turkish bath and the wet-pack, and, although these means are insuffi- 
cient of themselves to effect a cure, they aid very materially the ac- 
tion of other remedies. Increased metamorphosis of tissue and increased 
excretion are, it will be remembered, constant effects of these baths. 
If the wet-packing be used, free diaphoresis should be encouraged, by 
abundant covering and by large draughts of water. 

One of the most important recent improvements in therapeutics is 
the treatment of fevers by cold baths. This is an old expedient, it is 
true, but it is only within a few years that the treatment of fevers by 
baths has been placed within the domain of strictly scientific in- 
vestigation. Various means of applying water in fevers have been 
resorted to — cold affusion, cold baths, cold wet-pack, ice-bags, etc. 
Cold affusion consists simply in dashing successive buckets of water 
over the patient, stripped and lying on a mattress protected by a gum- 
cloth. The applications are continued until the temperature is re- 
duced. This is a crude method, and wears an aspect of harshness 
which may prevent its efficient use in private practice. The cold 
bath is more serviceable, and is free from the objectionable features of 
cold affusion. As practiced according to the method of Ziemssen, 
it is grateful to the patient, produces no shock, and exerts a powerful 
influence over the temperature. The fever-patient is put into a bath 
about the normal temperature of the body (98° Fahr.), and the water 
is cooled, by the addition of ice, to 80° Fahr., to 60° Fahr., or even to 
40° Fahr., according to the effect produced on the temperature, which, 
for this purpose, should be taken in the rectum. When a positive re- 
duction of the fever-heat has occurred, at the expiration of five min- 
utes to half an hour usually, or longer if necessary, the patient should 
be wiped dry, placed in bed, and covered with blankets. The bath 
may be used, according to the nature of the case, from two to six 
times each day, but less frequently if the duration be longer than a 
half -hour. The appliances for administering baths to fever-patients 
are : A strong sheet for lifting the patient from the bed into the bath- 
tub ; a bath-tub provided with an exit-pipe for drawing off the surplus 
water ; a thermometer for ascertaining the temperature of the bath, 
and a clinical thermometer for noting the variations of temperature 
of the patient. Hospitals should be provided with such arrangements 
as have been made at the London Hospital for the use of baths in 
fever. These consist of a small ward with two beds ; a bath-tub sup- 
plied with hot and cold water ; a tank, with which the cold-water pipe 
communicates, in which ice may be put if necessary ; and a large 
waste-pipe for disposing quickly of the surplus water. 



HYDROTHERAPY. 67 

In the absence of suitable bath appliances, the temperature of fever- 
patients may be reduced by simpler methods. Iced water may be 
injected into the rectum frequently ; cloths dipped in iced water may 
be applied to the trunk, and Chapman's ice-bags may be put to the 
spine. More suitable than these methods is the wet-packing. Al- 
though the wet-packing is not so effective as the bath, it is a very 
powerful means of reducing fever-heat, and it has the merit of sim- 
plicity of application, so that in every household it may be used if 
necessary. The patient may be put into the wet-pack several times 
each day, according to the state of the temperature, and may remain 
in it from five minutes to an hour. 

If, after the application of water by any of the modes above men- 
tioned, the circulation becomes feeble, the extremities cold, and the 
lips blue, stimulants should be administered and bottles of hot water 
applied to the feet. The good effects of baths are these : the temper- 
ature declines, the pulse falls and becomes soft and compressible, the 
skin grows moist, and the patient feels refreshed. The repetition of 
the bath or of the application of cold water will be determined by the 
rise of temperature, and of the pulse. Some practitioners employ them 
regularly, as, for example, Yon Ziemssen and Immerman, who admin- 
ister them at 6 a. m., 1 to 3 p. m., and 7 p. m. ; but others — and this the 
author thinks the better plan — give them more or less frequently ac- 
cording to the range of temperature. Not only is the mortality of 
typhoid greatly less under hydrotherapy than under any other method 
of treatment, but the complications which belong to it — except haem- 
orrhage — occur less frequently. 

The most conspicuous triumph of the water-treatment of the py- 
rexial state is seen in the management of hyperpyrexia, a condition of 
things in which a sudden and rapid rise of temperature takes place, 
the range being in extreme cases from 105° to 112° Fahr. It is now 
perfectly well known that any temperature above 108° Fahr. is almost 
necessarily a fatal sign. This condition of hyperpyrexia occurs some- 
times in acute rheumatism, delirium tremens, fevers, etc., and has here- 
tofore not been amenable to treatment. A fatal result in these cases 
may be averted by cold baths, the temperature of the bath being rap- 
idly reduced from 96° to about 60° Fahr., by the addition of ice. It 
is sometimes necessary in these cases to prolong the stay in the bath 
to two or three hours, but it must not be forgotten that no absolute 
rule can be made, the state of the patient's pulse, respiration, and tem- 
perature being the guide not only as to the temperature of the bath, 
but the duration of the stay in it. 

Typho-malarial fever is best treated by the same means ; but ma- 
larial fevers are, of coarse, so unquestionably remediable by quinine 
that any other treatment is a waste of time. Baths are, however, ex- 
tremely grateful in the pyrexial stage of malarial fevers. 



68 RESTOKATIVE AGENTS. 

Cold baths are of equal utility in scarlatina. In mild and uncom- 
plicated cases of this disease, no remedies are required, and simple 
sponging of the body, followed by inunctions of oil, is all that is 
required. When, however, the temperature rises to 104°, 105°, 106° 
Fahr., and higher, and there is delirium or stupor, the rash being dark 
and indistinct, and the urine scanty, the cold wet-pack will often ren- 
der most signal service. The rash will reappear and become vividly 
red ; the pulse, respiration, and temperature, will decline. The cold 
wet-pack to the neck, and frequent gargling of the throat with warm 
water, relieve the sore-throat, and are really more effective than the 
caustic applications so commonly resorted to. When the urine becomes 
scanty and highly albuminous, hot fomentations to the lumbar region, 
with or without addition of medicaments, are often very serviceable. 
The vapor-bath, or the warm wet-packing, by determining free dia- 
phoresis, relieves the brain when convulsions are threatened, or have 
actually occurred, from uraemia. 

Other eruptive diseases, measles, small-pox, cerebrospinal menin- 
gitis, are advantageously treated in the same way. 

Constitutional syphilis is very much ameliorated, and the cure by 
specific treatment hastened, by a course of Turkish baths, or wet-pack- 
ing. Three baths should be taken each week. If the wet-packing be 
used, the patient should remain in it until free diaphoresis is pro- 
duced. 

The wet-packing is very efficacious in acute rheumatism, but the 
prejudices of the patient, and of the patient's friends, often interfere 
to prevent its use. If there be much pain and soreness, the front of 
the body may be packed, and the inflamed joints may be separately 
swathed, but, whenever practicable, the packing should include the 
whole body. A vapor-bath is often very serviceable. A vinegar 
vapor-bath has been used, it is said, with great advantage. This ap- 
plication may be readily made in the following way : Some bricks 
are previously heated ; the bedclothes are elevated above the patient 
by hoops transversely placed ; and vinegar is poured over the heated 
bricks, which have been laid under the bedclothes. The perspiration 
which follows these baths should be wiped off, the skin quickly sponged 
with tepid water, and then dried with a soft towel. Great relief is 
experienced from these applications ; the joints are less tender, the 
fever declines, and the acid perspirations are diminished. Chronic 
rheumatism, if chiefly muscular, and if changes have not occurred in 
the joints, which are simply stiff, and chronic gout, are much benefited 
by the Turkish bath. 

In acute cerebral congestion, the cold douche may be applied to 
the head, while the feet are immersed in warm water. A piece of ice, 
held against the nape of the neck, acts powerfully in the same way. 
The alternate application of ice and hot water is often more effective 



HYDROTHERAPY. 69 

than ice alone. The author has seen these alternate applications of 
ice and hot water have an excellent effect in the stupor of opium nar- 
cosis, of uraemia, and in carbonic-acid poisoning, occurring under vari- 
ous conditions. 

Iu inflammatory affections of the meninges, and in meningeal haem- 
orrhage, a bag or bladder of pounded ice has the sanction of universal 
use. The author believes that these applications are often made with- 
out due discrimination in cerebral haemorrhage and other allied states. 
When the face is pale, the surface cool, and the circulation depressed, 
cold applications to the head are harmful. Ice to the head, and fric- 
tions of the surface with ice, are very serviceable in sunstroke or ther- 
mic fever, when the surface is hot, the pupils contracted, and the 
pulse full and bounding. The cold wet-packing gives great relief 
under the same circumstances, but, when the symptoms of depression 
exist, these cold applications are hazardous. Usually, however, in 
thermic fever, the range of temperature is very high, and the most 
important indication is to abstract the heat, which can be best accom- 
plished by application of ice or the cold wet-pack, or the cold bath. 
The results of the practice are in accordance with this theory, for 
these applications have been most successful in restoring patients in 
imminent danger of death. When, in delirium tremens, the head is 
hot, the conjunctivae injected, the face flushed, and the pulse strong, 
an ice-bag to the head, or cold affusion, or a mild douche, will assist 
in quieting the patient, and favor the production of sleep ; but these 
measures will do mischief when considerable depression of the bodily 
powers exists, and they are of doubtful utility in any case affording 
evidences of atheroma of the cerebral arteries, or of cardiac disease. 
Cold affusion to the head and spine, and cold baths, are among the 
most important means of relief in chorea. Wakefulness in children 
and adults may be often overcome, and quiet sleep insured, by a tepid 
bath taken just before retiring ; but, when the head is hot, the eyes 
brilliant, and the circulation active, cold should be applied to the head, 
while the body is immersed in the tepid bath. 

The shower-bath, the douche, and cold affusion, were formerly 
much used to calm the violence of acute mania and maniacal delirium. 
The great depression of the powers of life which the douche and the 
shower-bath have caused in some cases, and the fatal results which 
have occurred during their administration, have led to their disuse by 
many alienist physicians. By others, they are held to be extremely 
serviceable in appropriate cases. Bucknill and Tuke advise the oc- 
casional use of the shower-bath in the excitement of intercurrent mania 
and monomania, and a daily shower-bath in melancholia. They ad- 
vise, further, that the shower-bath should, in the first-named group of 
cases, be used no longer than three minutes, and in melancholia from 
fifteen to thirty seconds, the patient being dried while standing in a 



70 RESTORATIVE AGENTS. 

pan of hot water. The same authors prescribe a warm bath of thirty 
minutes, at 95° Fahr., for the excitement and sleeplessness of various 
forms of insanity, and they affirm that its "tranquillizing effect is 
often wonderful." The simultaneous use of cold affusion to the head 
and the warm bath has been warmly advocated by M. Brierre de 
Boismont, and is decidedly approved by Bucknill and Tuke, who ad- 
vise that the duration of the bath should not exceed one hour. The 
wet-pack is an exceedingly valuable remedy in the excitement of acute 
mania, but this measure should not be allowed to degenerate into a 
means of restraint merely. It should be applied in the mode already 
described, and the patient should continue in it until free diaphoresis 
is established. 

In infantile convulsions great benefit is derived from the general 
warm bath combined with cold affusion, or an ice-bag, to the head. 
Hysterical convulsions are quickly relieved in the same way, and the 
hysterical state is much improved by a daily shower-bath. 

Water, cold and warm, in the state of vapor, as ice, has been largely 
applied in the treatment of tetanus and hydrophobia, but without 
good results beyond the merest temporary assuagement of the patient's 
sufferings. 

Lesions of the spinal meninges and of the cord, corresponding 
pathologically to those of the brain, are remediable by similar means 
as respects hydrotherapy. The author has seen remarkable improve- 
ment follow a hot douche to the spine in a case of paraplegia of syph- 
ilitic origin. Erb reports remarkable curative results from the use 
of the " rubbing wet-pack " in chronic myelitis. He advises the use 
of merely tepid water, and opposes the application of the extremes of 
temperature, whether hot or cold. The backache so common in women, 
and frequently due to anaemia of the cord, may be much relieved by 
a sponge dipped in hot water and passed over the spine. The hot 
douche to the spine is often more decidedly serviceable in these dis- 
tressing cases. 

Alterations of sensibility, analgesia, anaesthesia, hyperalgesia, hy- 
peresthesia, are often relieved by hydrotherapy — by the wet-pack, by 
ice, by local hot and cold affusion. Neuralgic affections, especially 
sciatica, are benefited greatly by the wet-pack. Paralyzed parts that 
have become cold and that waste, and that are undergoing other nu- 
tritive changes, are improved in condition by douches, by wet-pack- 
ing, and other methods of the water-cure. 

In inflammatory affections within the chest, wet-packing is very 
useful. As a rule, a hot wet-pack gives more relief than a cold one, 
but the feelings of the patient are a proper guide. In acute pleuritis a 
cold wet-pack applied to the side unquestionably diminishes the pain, 
and no doubt relieves the inflammation. In pneumonia hot wet-packs 
are more suitable. When the organs within the chest are inflamed, it 



HYDROTHERAPY. 71 

is good practice to wrap the whole chest tightly in a pack to limit the 
motion of the chest-walls. The method of proceeding is as follows : 
Wring out in cold or hot water a large towel, fold it and place over the 
affected side or part ; have in readiness a bandage or long towel suffi- 
cient to encircle the chest, and confine the wet-pack by pinning as 
tightly as possible around the chest the bandage or towel. Spongio- 
piline is an excellent material for making these hot or cold applications. 
The same expedients — the application of cold and the tight bandage — 
are of great utility in pulmonary haemorrhage •, but a more decided 
effect, by means of ice-bags to the chest and back, may be procured in 
this condition of things. 

Cold and hot applications have unquestionable value in inflamma- 
tory affections of the abdominal organs. The author has seen excellent 
results from the application of an ice-bag over the swelling in cases of 
typhlitis and ^perityphlitis. Peritonitis is similarly treated with advan- 
tage. When the inflammation is recent, the abdomen may be covered 
with an ice-bag of sufficient size. It has been shown that not only may 
the local symptoms of inflammation be abated in this way, but the 
general temperature of the body be thus reduced. It is proper, in mak- 
ing these cold applications, to interpose a napkin or towel between them 
and the skin. 

Pounded ice is an excellent application to strangulated hernia to 
favor reduction, and this has often been sufficient when the taxis failed. 
Haemorrhoids that are much swollen and painful, or that bleed, are 
much improved by applications of ice. JBabo and swelled testicle 
are greatly benefited, and the pain attendant on them relieved, by 
ice. 

Cold to the abdomen in the form of ice or cold water, and ice-water 
thrown into the uterus, or ice introduced into the cavity of the womb, 
are measures of great utility in uterine haemorrhage, whether from 
threatened abortion or post partum. 

Hot-water injections, or the hot douche, is one of the most effective 
measures to be used in chronic metritis. A large quantity of water and 
frequent applications are needed to procure the best results. Not less 
than a quart of water as hot as can be borne, and three applications each 
day, are necessary. A Davidson's syringe, a vessel containing hot 
water, and a suitable vessel to receive the water as it flows away, are 
the materials needed for the vaginal douche. The first effect of this is 
to increase the blood-supply, but a marked degree of pallor of the mu- 
cous membrane follows, the opposite effect to that caused by cold 
water. When there is great relaxation of the vaginal passage and 
the uterus is large and spongy, the cold douche is more serviceable. 
Excellent results are sometimes obtained by the alternate use of the 
hot and cold douche. The free use of filtered rain-water has proved 
very efficacious in albuminuria, and to effect the solution of renal 



72 RESTORATIVE AGENTS. 

calculi. It must be drunk in large quantity. The good effects of 
Bethesda and of other weak alkaline waters must be referred to the 
same action ; for these waters can be drunk in larger quantity without 
distressing the stomach, than the hard waters. They must be used 
freely and for many months, to accomplish curative results. 

The applications of water in surgical practice are numerous and im- 
portant. As a dressing for icounds, contusions, and inflamed parts, it 
is in universal use. The author is convinced that the cold-water treat- 
ment of wounds is often overdone, the circulation in the wounded part 
being too much depressed, whence repair is slow, or sloughing is in- 
duced. The hot-water dressing, or the immersion of the affected part 
in hot water (95° to 100° Fahr.), as proposed and practiced by Prof. 
F. H. Hamilton, of New York, is a method which promises most suc- 
cessful results : 

" The phenomena usually observed in cases of recent lacerated or 
incised wounds, when submerged, are a sense of comfort, yet not abso- 
lute relief from pain ; on the second or third day the parts adjacent are 
swollen but not much reddened ; the integument generally assumes a 
white and sodden appearance, and with only slight tenderness. On the 
fifth, sixth, or seventh day the swelling is greater than usually ac- 
companies other plans of treatment, and, with the inexperienced, is 
likely to excite alarm; but it is found not to be attended with increased 
tenderness, and it pits under pressure, showing that it is a condition of 
oedema chiefly. At this time the granulations are generally covered 
with lymph, or some exudate of a whitish color, and which might easily 
be mistaken for a diphtheritic deposit. At the end of fourteen days or 
thereabouts (the period at which, in most cases, we substitute fomen- 
tation for submersion) the limb is still cedematous, the granulations are 
abundant, sometimes presenting a fresh red appearance, and at others 
covered with the white exudate." 

Prof. Hamilton further remarks : " No treatment hitherto adopted, 
under our observation, has been attended with equally favorable re- 
sults. Under this plan the area of acute inflammation is exceedingly 
limited ; erysipelatous inflammation has been uniformly arrested or re- 
strained when it has actually commenced, and it has never originated 
after submersion ; gangrene has in no instance extended beyond the 
parts originally injured, and, when progressing, it has in most cases 
been speedily arrested (in gangrene, hot water, or water at a tempera- 
ture of from 100° to 110° Fahr., is to be preferred). SejJticsemia and 
pyaemia have not ensued in any case in which submersion has been 
practiced from the first day of the accident. Purulent infiltrations 
and consecutive abscesses have been infrequent, and always limited to 
the neighborhood of the parts injured, and of small extent. Trau- 
matic fever, usually present after grave accidents, when other plans of 
treatment have been pursued, as early as the third or fourth day, has 



HEAT. 73 

seldom been present when this plan has been adopted, and in no case 
has the fever been intense or alarming." 

For the immersion of hand, foot, arm, and leg, Hamilton has con- 
structed bath-tubs of peculiar shape. He advises this method of 
treatment in contused or lacerated wounds of the extremities. Sim- 
ple incised wounds and amputations are unsuited to this plan of 
treatment. 

I subjoin the titles of some of the most recent and important con- 
tributions to our knowledge of the actions and uses of water. It is 
proper to add that I have also consulted the works of the followers 
of Priessnitz, but they are singularly deficient in accurate and scientific 
knowledge : 

Brand, Dr. Ernst. Die Heilung des Typhus, mit einem Anhang : Anweisung fur die 
Krankenwarter bei Behandlung des Typhus mil Badern, Berlin, 1868, A. Hirschwald. 

Braun, Dr. Julius. Systematisches Lehrbuch der Balneotherapies dritte umgearbeitete 
Auflage, Berlin, 1873, pp. 714. 

Fox, Dr. Wilson. Observations on the Treatment of Hyperpyrexia, London Lancet, 
vol. ii, 1871, p. 231, et seq. 

Hamilton, Dr. Frank H. TJie Medical Record, New York, vol. ix, May 15, 1874. 

Jurgensen, Dr. Theodor. Die Korperwdrme des gesunden Menschen (Studien), Leipzig, 
1873, p. 28, et seq. 

Liebermeister, Prof. Dr. Carl. Beobachtungen und Versuche uber die Anwendung 
des Tcalten Wassers bei fieberhaften Krankheiten, Leipzig, 1868, pp. 480. 

Ibid. Ziemssen's Cyclopaedia, American edition, vol. i, p. 206, et seq. 

Ibid. Handbuch der Pathologic und Therapie des Fiebers, Leipzig, 1875, p. 598, et seq. 

Valentiner, Dr. Th. Handbuch der allgemeinen und speciellen Balneotherapies George 
Reimer, 1873, pp. 850. 

HEAT. 

Physiological Actions. — It is difficult to assign heat to its proper 
position in a systematic classification. As a stimulant to the vital pro- 
cesses, it pertains to the class of agents promoting constructive meta- 
morphosis ; but, in its influence on the interchanges of repair and waste, 
the action quickly passes into the stage of waste. As its therapeutical 
employment is almost entirely confined to the range of constructive 
metamorphosis, it seems more appropriate to embrace it in this divis- 
ion of the subject. 

The normal heat-production of the body varies singularly little in 
health. Every considerable rise of temperature above, every consider- 
able fall below, the normal of 98*5° Fahr., indicates the existence of 
disease. The various external causes of disturbance of the heat-pro- 
ducing function of the body do not, in health, affect the normal stand- 
ard, because of the existence of a regulating apparatus. Every one 
is familiar with the fact that the human body can be exposed, without 
risk, to a temperature much above its own standard, provided the heat- 
regulating function is in a condition of healthy activity. If, however, 
the transmutation of heat into another mode of motion can not be 



74 RESTORATIVE AGENTS. 

effected, then the complexus of morbid actions, called fever, is at once 
established. Every increment of heat added to the body, unable to 
transmute it into another mode of motion, adds to the existing tem- 
perature. 

Yery important alterations take place in a body, the seat of a fe- 
brile process. Increased waste, the result of more rapid oxidation, 
occurs ; the excretion of urea, and, according to some authorities, of 
carbonic acid, is increased ; and those important and wide-spread le- 
sions, entitled parenchymatous degenerations, develop in various organs 
of the body. 

Modes of applying Heat.— 1. Solar Heat.— The rays of the sun 
may be applied directly to the whole surface, or to any part of the 
body. When the whole body is exposed to the rays of the summer 
sun, the head and face ought to be protected. The skin becomes 
warmer, the capillaries dilate, an erythematous blush appears, and the 
amount of blood in the peripheral vessels is increased above the nor- 
mal. The rays of the sun in midsummer, ranging from 95° Fahr. to 
125° Fahr., produce considerable burning heat, and cause a superficial 
inflammation of the skin, which is followed by desquamation. When 
the heat is less powerful, only an agreeable sensation of warmth may 
be experienced. Decidedly caustic effects may be produced by the 
concentration of the solar rays on a small spot of integument by a 
double-convex lens — a burning-glass, it has been called. This may be 
utilized as a means of counter-irritation. 

Besides the heat, the solar rays contain chemical or actinic rays ; 
and hence it is not improbable that chemical effects of a very impor- 
tant kind, or, it may be, catalytic effects, follow the application of the 
solar rays to a considerable portion of the body. Further, it can not 
be doubted that excitation of the cutaneous nerves by the heat and 
chemical rays of the sun must affect the condition of the brain and 
spinal cord, and, through the sympathetic system, the nutrition of 
the body. 

2. Artificial Heat. — There are various modes of applying arti- 
ficial heat. It may be dry or moist. 

Moist Heat. — Tlie Vapor-Bath. — It consists simply in the appli- 
cation of the vapor of water to the surface of the body. Sufficient at- 
tention, for the limits of this work, has been bestowed on this subject 
in the article on " Hydrotherapy." 

Dry Heat. — To the general surface of the body dry heat may be 
applied by simply raising the temperature of the air of the apartment, 
the body being uncovered. Local application of dry heat may be 
made to any part by means of woolen cloth, earthen plates, sad-irons, 
bags of salt, bricks, etc., heated to the proper temperature. The ef- 
fects of these applications depend largely on the amount of heat con- 
tained in these objects. They produce at first the sensation of warmth, 



HEAT. 75 

redness of the skin, and may cause vesication, or deep-seated burning 
and destruction of the tissues. 

The Turkish Bath. — This differs from the Russian bath, in that it 
consists of dry air without the presence of the vapor of water. The 
human body can exist in dry air at a very high temperature, without 
injury, for a short period, provided it is in a state of health. The 
temperature of the air of the Turkish bath ranges from 95° Fahr. to 
1G0° Fahr., but the highest point is attained at the conclusion of the 
process. There are usually three apartments, so that the patient 
passes from one grade of temperature to another, and thus avoids the 
unpleasant, even dangerous, effects of high heat suddenly applied. 
When the temperature reaches 110° Fahr., already some distress is ex- 
perienced. As the heat increases, the breathing becomes short, hur- 
ried, and labored ; the action of the heart is tumultuous ; an unpleas- 
ant sensation of heat and irritation, with itching, is felt over the whole 
body ; the head has a feeling of fullness, with constriction of the fore- 
head and ringing in the ears ; perspiration soon begins, and, when the 
temperature reaches the highest point, is very profuse. 

It is obvious that a decided impression is made on the organism by 
a Turkish bath. The first effect of the heat is on the sensory nerves — 
the impression of warmth. The peripheral vessels dilate, and, of course, 
admit into them a larger amount of blood, with the effect to diminish 
the amount of blood in the internal organs. The temperature of the 
blood rises with the increase of heat ; the action of the heart corre- 
sponds, and a state of fever would be quickly induced if the excess 
of heat were not at once disposed of by the perspiration, in which, ac- 
cording to the doctrine of the correlation of forces, it disappears as 
motion. The circulation being more rapid, and the peripheral vessels 
containing more blood, a more active metamorphosis of tissue proba- 
bly takes place. Elimination is more active through the skin, but is 
less active through the intestinal canal and the kidneys. The acidity 
of the urine is increased, and the water and salts are relatively dimin- 
ished. Remotely, the tension of the vascular system falls, absorption 
becomes more active, the muscular tonus declines, and the sensibility 
of the nervous system and of the special senses is lowered. 

Therapy. — Warm applications possess a high degree of utility in 
the various pa inful and inflammatory affections of the abdominal or- 
gans. Acute peritonitis, local or general, is probably more frequently 
benefited by applications of ice. As a rule, the feelings of the patient 
furnish the guide to the selection of the temperature. In the ab- 
sence of any specific indication from the feelings of the patient, 
the following rule may be adhered to : If the case be one of pain 
without fever or inflammation, warm or hot applications ; if inflamma- 
tory, cold. Those materials which retain heat and moisture longest 
are to be preferred ; for example, the material known as spongio- 



76 RESTORATIVE AGENTS. 

piline, poultices of flaxseed-meal, flannels wrung out in hot water and 
covered with oiled-silk, etc. When the weight of the application is 
objected to, a light material, like a bag of hops dipped in hot water, 
may be applied. In affections of the pelvic viscera, the same modes 
of application can be resorted to, under the same conditions. 

Heat, especially dry heat, is a very important remedy in sudden 
and alarming depression of the vital powers, with feebleness of the 
heart's action and coldness of the surface. Active haemorrhage, of 
course, contraindicates its employment. Feeble infants, born at term 
or prematurely, are often saved by the application of dry heat — the 
highest temperature which can be borne without blistering being ne- 
cessary. The methodus medendi is simple enough : the heating of 
the blood in the superficies of the body increases the movement of 
both heart and lungs. High heat, especially if long continued, is de- 
cidedly contraindicated in cases of fatty and fibroid degeneration of the 
heart, in cases of carditis, considerable obstruction of the orifices, etc. 

Hot-air baths, and hot applications of any kind, may be dangerous 
in old subjects, and in those persons of middle age who present the 
evidences of degenerated vessels. Not unfrequently, attacks of mi- 
graine, cases of ordinary neuralgia of the fifth, tic-douloureux of mild 
form, etc., are relieved by hot, dry applications made over the course 
and peripheral distribution of the affected nerves. Stupor and coma, 
due to uraemia, or to narcotic medicines, may be relieved by dry heat 
applied to the neck. The alternate use of cold and heat is generally 
more efficient. In neuralgia of the larger nerves, dry heat is pallia- 
tive. In irritable spine, the so-called spinal irritation, dry heat is an 
efficient remedy. In these cases solar heat is especially serviceable — 
the sun's rays falling on the spine, or, what is better, the rays concen- 
trated by a burning-glass on various points on the spine. 

Probably the most generally useful application of dry heat is in 
the treatment of chronic rheumatism and in general dropsy. In the 
treatment of these maladies, elimination is the object to be accom- 
plished: in the one case, of certain excrementitious substances, notably 
of uric acid ; and in the other, of water by the skin. 

The Turkish bath has an unquestionably good effect in constitu- 
tional syphilis. Here there are two objects to be accomplished — to 
promote the action of the mercurial medicines and of the ptisans, and 
to secure elimination through the skin. In the same way the Turkish 
bath is highly useful in plumbic, mercurial, and paludal cachexies. 
Our French colleagues maintain the superior value of sulphur-vapor 
baths in the cachexia? produced by the mineral poisons. 

AIR. 
The Atmosphere. — As a therapeutical agent, only, is air to be con- 
sidered here. Nevertheless, various hygienical relations of the subject 
are also therapeutical, and must therefore be included. 



AIR. 77 

Composition. — The atmosphere is a mechanical mixture of oxygen, 
nitrogen, and we should also add carbonic acid, and the vapor of water. 
In round numbers there are 21 parts of oxygen, 79 parts of nitrogen 
by volume, and 033 per cent of carbonic acid. The essential constit- 
uents — oxygen and nitrogen — are quite uniform in proportion in all 
parts of the world, but the carbonic acid and vapor of water vary con- 
siderably, owing to local causes. Contrary to the generally received 
opinions, the quantity of carbonic acid is greater at the tops of the 
highest mountains than on the plains, and the oxygen less. The 
amount of moisture is determined chiefly by temperature, and when 
the air can contain no more, it is said to be saturated. A trace of am- 
monia also is present in the air, and a minute quantity of active oxy- 
gen or ozone. 

When a beam of electric light is made to traverse the atmosphere, 
minute particles, previously invisible to the eye, and some even extra- 
microscopic, come into view. The lowest forms of life — microzymes, 
bacteria, etc. — are found in great numbers ; in cities, particles of car- 
bon, lime, and other earthy matters, fibers of cotton and woolen cloth, 
leather, ordure of animals, etc. ; in the country, pollen of plants, and 
particles of vegetable tissues ; in hospital wards, pus-cells and other 
matters derived from the persons, wounds and discharges, bedding, 
and utensils of the sick. We owe our present knowledge of these 
accidental constituents of the air chiefly to the researches of Prof. 
Tyndall. 

Various gaseous matters are also accidentally present in the air, 
varying in different localities in consequence of local telluric condi- 
tions, and certain trades and manufactures. As respects the first, there 
are carbonic acid and carbonic oxide, sulphureted and phosphureted 
compounds of hydrogen, marsh miasm, etc. Under the second may 
be included sewer-gas, gaseous emanations from decomposing animal 
matter, from chemical works of various kinds, etc. 

Physiological Effects. — 1. Pure Air. — When air is breathed in 
the process of respiration, the oxygen passes into the blood, and car- 
bonic acid, the vapor of water, a trace of ammonia, and some organic 
matter, pass out. The blood which leaves the lungs is changed in 
color, from the dark, purplish hue of venous, to the scarlet of arterial 
blood ; it has gained oxygen, and lost carbonic acid and water. The 
cause of the diffusion of gases in the lungs is chiefly the difference in 
tension of the gases in the blood and in the atmosphere — the tension 
becoming equal in the process of respiration (Hermann). 

In the tissues where oxidation processes are taking place, there is, 
also, a respiration process going on, consisting in the formation and 
excretion of carbonic acid. 

2. Impure Air. — So essential to life is the supply of oxygen to 
warm-blooded animals, that they can not be deprived of it, even for a 



78 RESTORATIVE AGENTS. 

very short time, without danger to life. As pure oxygen can not be 
inhaled for any considerable period without injury, admixture with 
some " indifferent gas " becomes necessary. Thus nitrogen is utilized 
in the formation of atmospheric air. The other indifferent gases are 
hydrogen and light carbureted hydrogen, or marsh gas : when mixed 
with oxygen, they can be breathed with impunity ; when inhaled 
alone, they cause dyspnoea and asphyxia. 

Certain other gases are entitled " irrespirable," because, owing to 
the chemical actions instantaneously set up, they can not be inhaled. 
Some of these irrespirable gases are acid — as carbonic, muriatic, hypo- 
nitrous, sulphurous, etc. ; others form acids by combination with oxy- 
gen, as nitric oxide, etc. ; others are alkaline, as ammonia ; others es- 
tablish an ozonizing action, as chlorine, bromine, etc. 

Other gases are comprehended in a group as " poisonous," of 
which there are three classes. The first class contains those which 
seize and combine with the oxygen of the blood, decomposing haemo- 
globin. They are hence called "reducing gases," of which sulphu- 
reted hydrogen, phosphureted hydrogen, etc., are examples. The 
gases of the second class displace the oxygen and enter into combina- 
tion with the haemoglobin. Carbonic oxide and nitric oxide are ex- 
amples of these displacing gases. The third class contains the gases 
used for the production of anaesthesia. 

In the process of respiration, the air loses its oxygen, nitrogen is 
relatively partly increased, carbonic acid accumulates, and certain ill- 
defined " organic matters " appear. This vitiated air exerts a most in- 
jurious influence, and soon becomes unfit to sustain life. The amount 
of carbonic acid which can be breathed without injury has not been 
definitely ascertained, but is greater than is commonly supposed. 
According to Pettenkofer and Yoit, 10 per 1,000 volumes produce no 
discomfort. When, in a crowded apartment, headache, vertigo, and 
feeble circulation are apparently caused by the quantity of carbonic 
acid present, these results are in part due to the lessened supply of 
oxygen, and to the action of nitrogen and organic matters. 

The foul air from cesspools and sewers affects the health of man 
in two modes : by the direct action of the gases of decomposition, 
and indirectly by acting as carriers of the germs of disease. As re- 
spects the former, its injurious influence has probably been exagger- 
ated ; for the original observation of Parent-Duchatelet, that workmen 
engaged in cleaning the sewers of Paris suffered from no diseases due 
to their occupation, has been abundantly confirmed in the subsequent 
experience of the French officials. It is probable, also, that certain 
persons possess a high degree of susceptibility to the action of sewer- 
gas, and are affected by comparatively minute quantities. When 
sewer-gas is admitted to private houses, and is breathed by such sus- 
ceptible persons, they decline in health, become easily fatigued, lose 



AIR. 79 

appetite and suffer with nausea and diarrhoea, waste, and have an 
earthy, sallow complexion. If the gas is more concentrated, they 
experience more acute symptoms, and have attacks of a choleriform 
character. Of course, asphyxia is produced when the gas is so con- 
centrated as to displace oxygen entirely, as is the case sometimes in 
old drains and privy-vaults, the air of which, as is well known, may 
extinguish life speedily. 

Sewer-gas, examined microscopically, is found to be loaded with 
minute particles, the lowest forms of life, etc., and hence it is in a high 
degree probable that the germs of fevers, dysentery, cholera, diph- 
theria, etc., may in a similar manner be conveyed by it. 

Effects of Compressed Air. — Our knowledge of this subject is de- 
rived in part from observations made on workmen engaged in under- 
ground avocations requiring them to labor under greatly increased 
barometric pressure ; in part from observations made on patients un- 
dergoing the compressed-air treatment ; and in part from experimental 
researches on animals. 

Not to enter too far into details out of place here, it suffices to 
state that the inhalation of compressed air lessens the respiratory 
movements and the number of heart-beats, and increases the arterial 
tension. The effect of this change in the conditions of the circulation 
is to diminish the amount of blood in the veins and auricles, and to 
increase it relatively in the ventricles (Sanderson). On ophthalmo- 
scopic examination of the fundus oculi it has been ascertained (Von 
Vivenot) that the blood-vessels of the retina diminished in size with 
the increase in the pressure. Compressed air does not appear to in- 
fluence materially the production of carbonic acid, but it does the 
absorption of oxygen (Yon Liebig). The changes induced in the 
phenomena of life under high barometric pressure have been carefully 
studied by Paul Bert, who seems to have established that the evil 
effects of such pressure are largely due to the formation of bubbles 
of gas in the blood. He finds that nitrogen is dissolved in the blood 
during the time of high pressure, and returns to the gaseous state 
when the pressure ceases. He further ascertained that the bubbles of 
gas obstructed the circulation at various points, especially in the lum- 
bar portion of the spinal cord, causing paraplegia. "When the ac- 
cumulation of gas was sufficient in amount, the pulmonary circulation 
was obstructed and the heart paralyzed by the sudden distention. 
MM. Blanchard et Regnard have studied the changes taking place 
in the spinal cord under the action of nitrogen. Numerous haemor- 
rhagic foci, and evidences of parenchymatous myelitis, were discovered 
in the entire cord. The myelitis presented the usual characteristics : 
hypertrophy and varicosity of the axis cylinder, and granular change 
at various points, but least pronounced in the lumbar portion of the 
cord, and most decided in the dorsal region. 



80 RESTORATIVE AGENTS. 

Air as a Therapeutical Agent. — As a general rule, the sick 
require more air-space than the healthy. The mere cubic dimensions 
are much less important than the amount of oxygen available for res- 
piration ; but as the sick are more readily affected by draughts than 
the healthy, it follows that the sick require more cubic space, and less 
frequent renewal of the air. It seems generally conceded that 2,000 
cubic feet of air-space per patient is necessary in hospitals and in the 
sick-room to supply the needed amount of oxygen, although a less 
space may be better if provided with the means of frequent changes 
of air without sudden variations of temperature and strong currents. 
A large cubic space of stagnant air will be inadequate to the require- 
ments of the sick. Even when so large an amount of air as 3,700 cu- 
bic feet per hour for each patient has been supplied to a hospital ward, 
the air in it has had a distinctly " stuffy " and offensive smell. Every- 
body is familiar with the fact that the sick and wounded do better in 
tents and in the open air, than in the best constructed military hos- 
pitals. 

If, as has been affirmed by the highest sanitary authorities, 1,000 
cubic feet of air-space is necessary to a healthy adult, it is clear that 
the sick require not less than we have named, 2,000 ; for the renewal 
of the air in the case of the latter must be less rapid. As the means 
for the renewal of the air in the sick-chamber in private houses consist 
of doors, windows, and fireplaces — or natural ventilation — the supply 
to the patient is variable. To insure the best results under these cir- 
cumstances, the bed should be so placed as to be without stagnant 
corners and recesses, and yet not within the range of currents or 
draughts. When the air is still, movements may be produced by 
burning a lamp in the chimney. In cold weather the fire in the fire- 
place induces a strong upward current in the chimney, the air coming 
from all the crevices. It would be quite beyond the subject-matter 
of this treatise to consider the various mechanical contrivances which 
have been proposed, and are now used, to secure proper ventilation in 
public institutions and hospitals ; but it may be useful to mention 
those devices by which natural ventilation in the sick-chamber may 
be promoted. 

Where there are opposite windows, cross-draughts may be prevent- 
ed by the following expedients : 1, by giving an upward slope to the 
window so that the current of fresh air is deflected toward the ceiling ; 
2, by having some of the window-panes doubled, the outer one having 
a space at the bottom of the pane, and the inner one at the top; 3, by 
fastening a block to the upper sash which prevents closing. If there 
are windows at one side only, the room may be efficiently ventilated 
by vertical tubes carried up the walls from some distance (a few feet) 
and communicating with the external air. k 

In the fevers, exanthemata , diphtheria, dysentery, etc., an abun- 



AIR. 81 

dant supply of air is a measure of the highest utility. The result in a 
doubtful case may be determined by the amount of oxygen received 
by the patient. Furthermore, free admission and exit of air is the 
most efficient means of destroying disease-germs, and their retention 
in a stagnant atmosphere intensifies their virulence. In febrile affec- 
tions, the apprehension of " taking cold " may be allayed by the assur- 
ance that the condition of fever is preventive. Draughts, however, 
should be avoided in measles and in all affections of the breathing 
organs. 

There are two conditions in diseases of the respiratory organs, in 
which an abundant supply of air is essential : inflammatory affections 
in which the breathing space is encroached upon so that the oxygena- 
tion of the blood is hindered ; and chronic maladies, as emphysema, 
asthma, etc., in which labored breathing is a consequence in part of 
mechanical defects. Considerable diminution in the supply of air has 
a powerful influence in the production of consumption. The statistics 
on this point collected by the English Sanitary Commission seem con- 
clusive, and, since their recommendation of increased cubic air-space in 
the barracks, the number of cases of phthisis has materially diminished. 
In the treatment of this disease, a suitable supply of air becomes 
even more imperative. The subjects of this disease should occupy 
apartments, whenever practicable, provided with ample windows and 
fireplace, and frequent renewal of the air day and night should be 
secured by some of the contrivances now used for this purpose and al- 
ready referred to. Whenever, by reason of fever or debility, exercise 
in the open air can not be taken, the patient, suitably clad and pro- 
tected in severe weather, may sit in an apartment with all the win- 
dows and doors open, a part of each day. 

Maladies characterized by a deficiency in the oxidation processes 
throughout the body require increased supply of air under all the cir- 
cumstances of life. The most important of these are diabetes, gout, 
rheumatism, obesity, excess in the production of lithates, etc. The 
good effects of open-air exercise in these disorders result chiefly from 
the increased consumption of oxygen. Anaemia, chlorosis, convales- 
cence from acute diseases, and chronic wasting maladies, also require 
increased consumption of air : the oxygen is even more important than 
the iron which is given so profusely in these cases ; indeed, without 
additional oxygen, the assimilation of the iron can hardly be accom- 
plished. 

Therapeutical Applications of Compressed Air are effected 
by two modes : by placing the patient in a chamber in which the air 
has been condensed by an air-pumping engine ; and by having the 
patient breathe, through a mask closely fitting the mouth and nose, air 
compressed in a portable reservoir. The latter method only is ordi- 
narily available. Without entering into minute details, it will suffice 
6 



82 RESTORATIVE AGENTS. 

to say that the former method consists of an air-tight chamber eight 
feet high and seven feet wide, in which three patients can sit comfort- 
ably. The air is compressed gradually to one and a half atmospheres 
— a pressure of twenty-two pounds to the square inch — and the pa- 
tient remains in the chamber about an hour and a half. One of the 
first and most complete arrangements of this kind was erected under 
the supervision of Dr. Liebig (not the chemist) at Reichenhall, Bava- 
ria ; and he has since communicated the results of his large experience 
to the Aerztliches Intelligenz-JBlatt of Munich. The portable apparatus 
now most used is that of Waldenburg (der transportable pneumatische 
Apparat). This consists of an outer cylinder containing some water, 
and an inverted inner cylinder containing air, which fits into the outer 
one. Obviously the air within may be condensed or rarefied by low- 
ering or raising the inner cylinder, which is easily effected by applying 
weights. A mercurial manometer indicates the degree of condensa- 
tion, and a water-gauge the height of the water. With the air-cham- 
ber a flexible tube, having an oro-nasal mask attached, communicates. 
With this apparatus the patient breathes either condensed or rarefied 
air at the will of the operator. The author has had arranged for his 
own use a pneumatic apparatus which can be employed for inhalation 
of compressed or rarefied air, and for the atomization of liquids. It is 
only available in cities where a sufficient water-pressure can be ob- 
tained. It consists of a brass cylinder strongly made, and containing 
at the top a stop-cock and pipe for the admission of water, and at the 
bottom a stop-cock for drawing off the water. At the top, also, there 
is a stop-cock and pipe for the attachment of the flexible tube and 
oro-nasal mask, and a gauge for registering the pressure. The admis- 
sion of water effects the compression of the air ; its removal — all the 
stop-cocks being closed — effects the rarefaction. Precisely the same 
results can be attained as in the more complicated arrangement of 
Waldenburg. Furthermore the author's apparatus can be employed as 
an atomizer, using compressed air or steam. 

The applications of compressed air are numerous and important. 
The results are chemical and mechanical. The chemical effects are 
due to the increased supply of oxygen ; the mechanical, to the distri- 
bution of the blood-pressure. In ahaimia, chlorosis, amenorrhoea, in 
the neuralgia?, especially of the fifth nerve, headache, epistaxis, in 
gout, diabetes, obesity, etc., very excellent results are obtained by the 
use of compressed air — which means the increased consumption of 
oxygen. To achieve all that is possible to effect in these cases, the 
treatment must be continued for a considerable time. 

It is, however, in certain cardiac and pulmonary affections that the 
pneumatic treatment is especially commended. Acute catarrh, nasal, 
faucial, bronchial, if early applied ; chronic bronchitis, with or with- 
out emphysema, capillary bronchitis, atelectasis, asthma, dilatation of 



MASSAGE. 83 

the right cavities, and fullness of the venous with ischaemia of the ar- 
terial system, are conditions in which the compressed air is signally 
beneficial. Probably in emphysema, more than in any other malady, 
has the relief afforded by this treatment been most conspicuous ; for 
this is a disease which has hitherto offered few results to therapeutical 
skill. " Die Exspiration in verdiinnter Luft ist das specifische mecha- 
nische Antidot des Emphysems," is the dogmatic statement of Walden- 
burg — "Expiration into rarefied air is the specific mechanical antidote 
to the emphysematous affections." 

The rules for the inspiration and expiration of rarefied and con- 
densed air respectively may be formulated as follows : 

As inspiration of condensed air increases the intra-thoracic air- 
pressure, it impedes the flow of blood to the right auricle, and lessens 
somewhat the pulse-rate, and is accordingly indicated in cases of dysp- 
noea having a mechanical origin, in incipient phthisis, in asthma, bron- 
chitis, and in insufficiency of the mitral. 

As inspiration of rarefied air has the opposite effects to those of 
condensed air, its use is indicated in the few cases in which increased 
inspiratory power is desirable, as in contracted thorax, the result of 
effusion. 

Expiration into condensed air increases the expiratory power when 
deficient, and expiration into rarefied air is indicated in emphysema 
and chronic bronchitis. 

Authorities referred to : 

Bert, Dr. Paul. Comptes Rendus, vol. lxxiii, quoted in London Medical Record, vol. 
i, p. 375. 

Burdon-Sanderson, Dr. J. The Salt and Compressed- Air Cure of Reichenhall. The 
Practitioner, vol. i, p. 218. 

Vox Liebig, Dr. Aerztliches Intelligenz-Blatt. London Medical Record, vol. xi, p. 
473. 

Von Vivenot, Dr. Rcdolf. Virchovfs Archiv, Band xxxiv, p. 515. 

"Waldenburg, Dr. Die pneumatische Behandlung der Respirations- und Circulations- 
Kranklieiten, etc. Hirschwald, Berlin, 1875. 

MASSAGE. 

Definition. — The term massage is probably derived from the 
Arab word mass, which signifies " to knead." The French word mas- 
sage is equivalent to the term shampooing, and is applied to a process 
of rubbing, friction, and percussion of the body. Masseur is a male 
rubber, and masseuse a female rubber — that is, persons who make a 
business of massage. 

Method. — Massage by friction consists in rubbing, rolling under 
the fingers, and gently pinching the skin, and rubbing, tapping, knead- 
ing, and exercising the muscles and joints. Beginning at an extrem- 
ity, the foot for example, the skin is taken up between the thumb and 



84 RESTORATIVE AGENTS. 

fingers and rolled and pressed ; then the muscular masses are well 
grasped, rolled and pressed and kneaded, and rapidly tapped a quick 
succession of light blows ; and then each articulation is in turn put 
through all of its motions. Even the muscles of the neck and the in- 
terossei may be subjected to the same treatment, with a little address 
and painstaking. In fact, no part of the body should be omitted ex- 
cept the face. 

Massage by percussion alone consists in applying to various parts 
of the body a very rapid succession of short blows, not forcible enough 
to cause pain. The blows or taps may be made with a wooden spatula, 
with the fingers as arranged for percussion, or with the lateral margin 
of the hand fully extended. 

Dr. Mortimer Granville has accomplished notable results in the 
treatment of neuralgia by rapid percussion over the trajectory of the 
nerves affected. He has devised a small instrument for this purpose, 
called percutier. The curative results of this delicate percussion are 
attributed by Granville to a modification in the nerve-molecules. 

Physiological Effects. — The good effects of massage are popu- 
larly ascribed to electrical or supernatural agency. That electrical 
currents are induced by massage is true, but the curative effects are 
attributable to other agencies. 

The effects of massage are : 1, local ; 2, systemic. 

1. The masseur or rubber puts forth more or less muscular power, 
which at the points of contact or friction develops or is transformed 
into another mode of motion — heat. The action thus induced in the 
constituent tissues of the parts operated on, also serves to elevate the 
temperature. The vessels dilate and an increased quantity of blood 
enters them, and the motion of the blood-current is accelerated. The 
immediate effect of these changes is to promote the nutritive energy 
of the tissues subjected to friction. This result is seen in the im- 
proved color, warmth, and volume of the parts. 

2. A general rise of temperature, equal in most instances to one 
degree, has been observed to take place quite uniformly (Mitchell). 
The body increases in weight ; all the organic functions are performed 
with more energy, and power is gained in every way. Massage in its 
several forms exercises peculiar effects on the nervous system, which 
should not be overlooked. When an inflamed part which can be ma- 
nipulated, a joint for example, is rubbed with excessive gentleness, 
the sensibility, which was at first so acute that every touch gave pain, 
rapidly subsides, until, after an hour of friction, it may be handled 
with some roughness, without evoking painful sensations. When the 
local condition is that of pain merely, it is remarkable how the acutest 
suffering is alleviated by persistent friction of a gentle kind. Again, 
the state of spasm of a muscle is relieved and relaxation induced by 
persevering rubbing of the affected muscle. Results such as these are 



MASSAGE. 85 

explicable only on the theory that the gentle titillation of the cutane- 
ous branches of the nerves (end-organs) has so far lowered their irri- 
tability that they cease to receive and transmit painful impressions. 
The rapid and long-continued transference to the centers of conscious 
impressions of the gentle titillation of the end-organs allays the irri- 
tability of the center, so that, if pain be transmitted, it excites no re- 
action, and therefore is not realized. 

Therapy. — Obstinate wakefulness and nocturnal restlessness may 
often be relieved by massage of pressure or percussion. Very gentle 
and long-continued friction of the extremities, especially of the lower 
extremities, is necessary, or corresponding tapping. Simple headache, 
even severe paroxysms of neuralgia, and the spasms of tic douloureux, 
are often most surprisingly relieved by, at first, exceedingly delicate 
frictions of the end-organs of the fifth — the skin of the face, forehead, 
neck, and the scalp — and subsequently stronger rubbing of the same 
parts. The same method has been effective in hemicrania, migraine, 
and spinal pain (Westerlund, Graham, Putnam, and others). Next to 
electricity, massage is the most useful remedy we possess in the treat- 
ment of infantile paralysis and other wasting palsies, after the acute 
symptoms have subsided. In hemiplegia and other forms of paralysis 
due to intra-cranial lesions, the indications for the treatment by mas- 
sage are a lowered state of the nutrition of the paralyzed parts, cold- 
ness and blueness of the skin, wasting and contracted muscles, ulcer- 
ations, etc. In progressive muscular atrophy, much more may be 
accomplished by persistent frictions and kneadings of the wasting 
muscles. The treatment should be begun early, and the first indica- 
tions — pain, fibrillary trembling, weakness, etc. — require the massage, 
without waiting for obvious wasting. Of course, any treatment is 
useless when the wasting has proceeded so far that no muscular ele- 
ments remain. 

Probably massage has accomplished more conspicuously good re- 
sults in chronic joint affections, synovitis, contractions and deformities, 
and thickening from inflammatory deposits (Berghmann and Helle- 
day, Billroth, Mosengeil, and others). It is in this class of cases that 
healers, natural bone-setters, and other empirics sometimes achieve 
surprising success in the face of failures by regular surgeons. The 
author therefore especially urges on young surgeons and physicians 
the extraordinary utility of massage in this group of cases, and the 
great results which can be achieved by it, when sections of muscles, 
tendons, and cicatrices may appear to be imperatively demanded. In 
many cases patient and long-continued use of the method may be re- 
quired. 

In the hands of Weir Mitchell, massage has proved of surprising 
benefit in cases of the so-called spinal irritation, with its protean 
manifestations in the nervous, muscular, digestive, and sexual systems. 



86 RESTORATIVE AGENTS. 

He uses it as a means of promoting the nutrition of the body generally, 
and of the muscular system particularly, while he maintains the body 
in a condition of nearly absolute rest. 

As the results obtained have been surprisingly great, it were better 
to indicate with some particularity the kind of cases to which massage 
seems best adapted, and we can do no better than employ the graphic 
language of Mitchell : " It includes that large group of women, espe- 
cially, said to have nervous exhaustion, or who are described as having 
spinal irritation, if that be the prominent symptom. To it I must add 
cases in which, besides wasting and anaemia, emotional manifestations 
predominate, and which are then called hysterical, whether or not they 
exhibit ovarian or uterine disorders. Nothing is more common in 
practice than to see a young woman who falls below the health- 
standard, loses color and plumpness, is tired all the time, by-and-by 
has a tender spine, and soon or late enacts the whole varied drama of 
hysteria. . . . But no matter how it comes about, the woman grows 
pale and thin, eats little, or, if she eats, does not profit by it. Every- 
thing wearies her — to sew, to write, to read, to walk — and by-and-by 
the sofa or the bed is her only comfort." 

" In the treatment of these, massage plays an important part. Rest, 
electrical excitation and exercise of the muscular system, systematic 
feeding, are employed in conjunction with massage." 

How far the results in the treatment by massage are affected by 
psychical impression has not been ascertained. The separation of 
these patients from home influences and associations, the confinement 
to bed, and the novel treatment, combine to affect the imagination 
profoundly, and to arouse hope and expectation to the highest point. 
In the class of cases described by Mitchell, these mental influences 
are powerful factors both in causing and curing morbid mental states. 
In illustration may be quoted Davy's celebrated case of paralysis cured 
by the mere application of the thermometer, and the remarkable re- 
coveries which occurred under the religious ministrations and prayers 
of Prince Hohenlohe. 

The extraordinary effects produced by the application of certain 
metals in hysterical subjects (Burq's Metallotherapy) may also be 
quoted in illustration. The results obtained by Charcot from metallo- 
therapy have been even more remarkable than the cures effected by 
Mitchell with massage. 

Authorities referred to : 

Berghman and Helleday. Nord. Med. Ark., vol. i, No. 7, 1873. Schmidt's Jalir- 
bucher, vol. clxvi, p. 158. 
Fate, Dr. L. Ibid. 

Graham, Dr. Douglas. Boston Medical and Surgical Journal, xciv, 6, p. 150. 
Le Blond, Dr. N. A. Manuel de Gymnastique, etc., Paris, 1877, p. 228, et seq. 
Mitchell, Dr. S. Weir. Fat and Blood, J. B. Lippincott & Co., Philadelphia, 1877. 



DIGESTION-FERMENTS. 87 

Piorry, Dr. Dictionnaire des Sciences Medicates, vol. xxxi, art. Massage. 
Putnam, Dr. James. The Boston Medical and Surgical Journal. 
Trousseau et Pidoux. Traite de Therap. et de Mat. Med., vol. ii, p. 91. 
"Westerlund, Dr. Schmidt's Jahrbucher, vol. clxvi, p. 158, op. cit. 

DIGESTION-FERMENTS. 

Pepsin. — Pepsina vel pepsinam ; pepsina porci ' pepsine, Fr. ; Ver- 
dauungsstoff, Ger. 

Definition. — A ferment obtained from the mucous membrane of 
the stomach of the pig. There are two processes worthy of mention 
for obtaining the ferment : Scheffer's, and Prof. Lionel S. Beale's. By 
Scheffer's process the mucous membrane is digested in a solution of 
muriatic acid, and the pepsin precipitated with chloride of sodium. 
Beale directs that the mucous membrane be first cleansed and then 
scraped strongly with an ivory knife, so as to remove the contents of 
the gastric glands. The pepsin is contained in the very viscid mucus 
which is thus removed. When spread on clean glass in a very thin 
layer, it is dried at a temperature not to exceed 100° Fahr., and in the 
vapor of hot water or over sulphuric acid. 

Preparations. — Pepsinwn Saccharatum. — Pepsin and sugar of 
milk. " One part of saccharated pepsin dissolved in 500 parts of 
water acidulated with 7*5 parts of hydrochloric acid should digest at 
least 50 parts of hard-boiled egg-albumen in five or six hours, at a 
temperature of 100° to KM Fahr." Dose, 3 j— 3 ij. 

Liquor Pepsini. — Solution of pepsin is composed of saccharated 
pepsin in solution in water and glycerin, and acidulated with hydro- 
chloric acid. Dose : a teaspoonf ul ter in die, usually after meals. The 
wine of pepsin is an unscientific preparation, and should not be pre- 
scribed. Boudault's (really Corvisart's) compound nutritive powder, 
consisting of pepsin, starch, and lactic acid, is an exceedingly uncertain 
preparation, and is often totally inert. Only those preparations of 
pepsin should be used, made by the processes above described, espe- 
cially those of E. Scheffer, of Louisville, Ky. The saccharated pepsin 
and the glycerole are practically unchangeable. 

Ingluvin. — This is a preparation from the gizzard of the domestic 
chicken — ventricidus callosus gallinaceus. Dose, gr. v — 3 j. 

Ingluvin has the remarkable property of arresting certain kinds of 
vomiting — notably the vomiting of pregnancy . It is a stomachic tonic, 
and relieves indigestion, flatidence, and dyspepsia. 

The author's experience is confirmatory of the statements which 
have been put forth regarding the exceptional power of this agent to 
arrest the vomiting of pregnancy. It can be prescribed in inflam- 
matory conditions of the mucous membrane, as it has no irritant effect. 
Under ordinary circumstances, and when the object of its administra- 
tion is to promote the digestive function, it should be taken after 



88 RESTORATIVE AGENTS. 

meals. When the object is to arrest the vomiting of pregnancy, it 
should be given before meals. 

Recent investigations have shown that ingluvin owes its curative 
effects, not to any ferment corresponding to pepsin, but to a peculiar 
bitter principle. This result is the more satisfactory, since such an 
organ as the gizzard could hardly furnish the necessary quantity of a 
digestive ferment to effect the changes now known to be produced by 
ingluvin. 

Pancreatin. Pancreatic Emulsion. Liquor Pancreaticus. — 
Pancreatin is the ferment of the pancreas. Under the name pancre- 
atic emulsion it has long been used as a means of promoting intes- 
tinal digestion, especially the digestion of the fats. The most effective 
preparation is liquor pancreaticus, obtained by digesting minutely 
divided fresh pancreas with a weak alcoholic solution. As too much 
alcohol injures the ferment, and too little will fail to prevent decom- 
position, it is a nice point to determine the amount most suitable. Five 
per cent of alcohol is probably a near approximation to the proper 
amount. Pancreatin differs from pepsin in that its action is promoted 
by an alkaline condition, and destroyed by strong acidity. In the 
presence of an alkali it has the power to convert proteids into peptones, 
to emulsionize fats, etc. As acids destroy pancreatin, it follows that 
the liquor pancreaticus should not be given while stomach digestion is 
going on, but when the chyme has entered the intestine, in about three 
hours after the taking of food (Roberts). 

In cases of very weak digestion, Roberts suggests the employment 
of "peptonized" foods — i. e., foods that have been acted on by pan- 
creatin and the proteids converted into peptones. The following 
formulae proposed by Roberts will be found useful in some conditions 
of disease : 

"Peptonized Milk. — A pint of milk is diluted with one fourth 
water, and heated to 140° Fahr. Two or three teaspoonfuls of liquor 
pancreaticus, and ten to twenty grains of bicarbonate of soda, are 
then mixed therewith. The mixture is then poured into a covered 
jug, and the jug is placed in a warm situation under a ' cozy ' in order 
to keep up the heat. At the end of an hour or hour and a half, the 
product is boiled for two or three minutes. It can then be used like 
ordinary milk." 

"Peptonized Gruel. — Gruel may be prepared from any of the nu- 
merous farinaceous articles which are in common use — wheaten flour, 
corn-meal, oatmeal, arrow-root, sago, pearl-barley, pea-flour. The 
gruel should be very well boiled, and made thick and strong. It is 
then poured into a covered jug and allowed to cool to a temperature 
of about 140° Fahr. Liquor pancreaticus is then added in the propor- 
tion of a tablespoonful to the pint of gruel, and the jug be kept warm 
under a * cozy ' as before. At the end of a couple of hours the prod- 



PEPSIN. 89 

uct is boiled and finally strained." In this process the starch is con- 
verted into sugar, and the albuminoid matters are peptonized, whence 
the gruel assumes a thin, watery consistence. Peptonized gruel is 
administered with peptonized milk. 

"Peptonized milk-gruel is prepared as follows : Gruel is prepared 
in the usual way, thick and strong ; to this while boiling is added an 
equal measure of milk. To each pint of the mixture add two or three 
teaspoonfuls of liquor pancreaticus and twenty grains of bicarbonate 
of sodium. It is kept warm for a couple of hours, then boiled for a 
few minutes and strained." 

Papaiva or Papain. — MM. Wurtz and Bouchut have given this 
name to a ferment obtained from the Carica papaya. On incising the 
green plant, a milky juice exudes. This juice is white, slightly as- 
tringent, but not acrid, and contains the ferment papain, which being 
soluble in alcohol, may by this means be separated. Papain has very 
active digestive power, effecting the solution of albuminous substances 
in a short time. It is found to be an active solvent of false mem- 
brane ; of the intestinal worms, ascarides and taenias. That it is a true 
ferment, with power to convert albuminoids into peptones, is denied 
by Catillon. Although it may not properly be substituted for pepsin 
in stomachal affections, it may be utilized as a solvent in the maladies 
above mentioned — false membrane of diphtheria, ascarides vermicu- 
lares, tape-icorm, etc. 

Antagonists and Incompatibles. — Alkalies and the mineral salts 
which precipitate pepsin from its solutions (mercury, lead, zinc, and 
copper salts), tannic and gallic acids, creosote, etc., are incompatible. 
Alcohol and the various alcoholic liquors, in sufficient strength, destroy 
the activity of pepsin ; hence the wine of pepsin must be an uncertain 
preparation. 

Synergists. — Lactic and chlorhydric (muriatic), acetic, citric, and 
malic acids, promote the digestive activity of pepsin. Certain fer- 
ments, as ptyalin, pancreatin, extracts of malt, etc., also increase its 
activity. 

Physiological Effects. — Ten grains of the saccharated pepsin, 
prepared by the process of Scheffer, will dissolve 120 grains of coagu- 
lated albumen in four to six hours, at a temperature of 100° Fahr. 
Pepsin is an essential constituent of the gastric juice, and possesses 
the property, especially in the presence of lactic and chlorhydric acids, 
of digesting the nitrogenous constituents of the food (casein, albumen, 
fibrin, etc.), and converting them into peptones. 

Therapy. — Pepsin is, of course, indicated in stomach- disorders 
characterized by a deficiency of this essential principle. As Fenwick 
has shown, the amount of pepsin secreted by the gastric glands un- 
dergoes great diminution in various morbid states, as in cancer, dia- 
betes, typhoid fever, and heart-disease. In convalescence from fever, 



90 RESTORATIVE AGENTS. 

therefore, pepsin is indicated, and in the incurable morbid states, men- 
tioned above, it serves a useful purpose in maintaining the function 
of digestion. Fox " bears strong testimony in favor of pepsin " (p. 74) 
in cases of atonic dyspepsia and "irritative states of the mucous 
membrane." He prefers to administer it with chlorhydric acid. In 
the atonic dyspepsia of phthisis pepsin is highly beneficial, especially 
when given in connection with pancreatic emulsion. In other forms 
of dyspepsia, accompanied by imperfect solution of the fats and the 
formation of fat-acids, the addition of pancreatic solution greatly in- 
creases the activity of pepsin (Long). 

In the apepsia of infants (Barthez), especially occurring in those 
artificially fed, great benefit is derived from the use of pepsin. Dr. 
Cummins has seen many apparently hopeless cases recover under its 
use, and he regards it as so valuable that he never recommends a wet- 
nurse, but relies on artificial food, the digestion of which is aided by 
the administration of pepsin. Corvisart used his nutritive powder 
(the so-called Boudault's pepsin) with happy effects in the same cases ; 
and Barthez, who applied the term apepsia to this inability of infants 
to digest their proper aliment, has been equally successful in the same 
mode of treatment. The saccharated pepsin should be administered in 
these cases in doses of ten to thirty grains immediately after the child 
has taken its milk or other food, or thirty minims of the glycerole of 
pepsin at the same time. It is better, according to M. Barthez, to 
give pepsin without acid to infants (Trousseau et Pidoux). 

Pepsin is one of the remedies which have been used with success 
in the vomiting of pregnancy. 

By facilitating digestion, pepsin relieves the pain and distress 
caused by deficient elaboration of the foods ; hence its utility in re- 
lieving the heaviness and torpor which are felt during the progress of 
digestion in some subjects, and also the gastralgia which is produced 
in this way. 

According to Hollman, the use of pepsin is attended with beneficial 
results in ancemia, chlorosis, atrophy, and allied states, due, no doubt, 
to the better preparation of the peptones for absorption into the 
blood. 

In chronic idcer of the stomach and in cancer of this organ, pep- 
sin, by facilitating digestion, will diminish the distress of the patient, 
and will contribute to the cure of ulcer and prolong life in cases of 
cancer. 

Very great success has been attained in the treatment of diarrhoea 
in infants by pepsin. The form of diarrhoea amenable to this remedy 
is due really to an atonic state of the intestinal mucous membrane. 
Every motion contains half-digested food. Soon after taking milk or 
other food, the child becomes uneasy and a discharge takes place. 
Frequently undigested food is vomited as well. If this condition of 



PEPSIN. 91 

things continues for any considerable time, the child emaciates, and 
the skin wrinkles and becomes dry and harsh. The motions will be 
quickly changed in character, and the nutrition of the child improved, 
by giving pepsin immediately after each supply of food. Facts in 
illustration of this statement have been published by Corvisart, Bar- 
thez, Rilliet, Trousseau et Pidoux, Ellis, of Dublin, Davidson, of 
Liverpool, Hawley, of Brooklyn, and others. 

In cases of entire inability of the stomach to digest food, or when 
surgical operations or accidental injuries prevent the introduction of 
aliments into this viscus, pepsin is added to the nutritive enemata 
in order to insure the preparation of peptones for absorption. Mr. 
Malcolm Morris reports the cure of an obstinate case of eczema 
by the administration of papain. It was due to indigestion, it is 
probable. 

Pepsin and papain are also applied to certain local uses. After 
the publication of Broadbent's results from the injection of acetic acid 
into cancerous tumors, Thiersch and Nussbaum introduced the method 
of gastric- juice injections into the substance of morbid growths. The 
gastric juice of the pig carefully filtered, or a slightly acidulated solu- 
tion of pepsin, may be employed for this purpose. The injection 
should be made with a hypodermatic syringe, and the solution should 
be deposited well into the interior of the tumor. This practice may 
be useful in cases of fatty tumor or other benign growths, when from 
any cause extirpation may not be practicable. That malignant tumors 
may be retarded in growth by this practice is also quite probable, un- 
less the neighboring lymphatics are involved. 

Authorities referred to : 

Cummins, Dr. W. Jackson. Dublin Journal of the Medical Sciences, February, 1872. 

Davidson, Dr. A. The Practitioner, vol. viii, p. 131. 

Ellis, Dr. G. A. The Medical Times and Gazette, July 19, 1862. 

Fenwick, Dr. Samuel. The Morbid States of the Stomach and Duodenum, London, 
1868, pp. 394. 

Fox, Dr. Wilson. On the Diseases of the Stomach, London, 1872, pp. 236. 

Gueler, Prof. A. Commentaires Therapeutiques du Codex Medicamentarius, Paris, 
1868, pp. 1U. 

Hollman, Dr. J. P. Schmidt's Jahrbucher dcr gesammten Medicin, vol. exxxi, 
p. 165. 

Long. Pharmaceutical Journal, London, 1870, quoted in Wood's New Remedies. 

Meisner, Prof. Ueber Krebs, Schmidt's Jahrbucher, etc., vol. cxlvi, p. 346. 

Xussbaum, Prof. Schmidt's Jahrbucher, etc., vol. exxxv, p. 38. 

.Roberts, Dr. William. Lumleian Lectures, On the Digestive Ferments, April 3, 
1880, April 10, 17, 24, and May 1, 8, 15, 22, and 29, 1880. 

Stephenson, Dr. W. Edinburgh Medical Journal, November, 1865. 

Trousseau et Pidoux. Traite de Therapcutique et de Matiere Medicale, huitieme 
edition, vol. i, p. 64. 

Wurtz, M. Annuaire de Therapcutique, etc., for 1S81, p. 202. 



92 RESTORATIVE AGENTS. 

ACIDS. 

Acidum Lacticum. — Lactic acid ; acide lactique, Fr. ; Milchsaure, 
Ger. 

Properties. — It is an acid, sirupy liquid, which contains 75 per 
cent of absolute lactic acid, and has a pale wine-color. Specific 
gravity, 1*212. It mixes in all proportions with water, alcohol, and 
ether. 

Incohpatibles and Antagonists. — Alkalies and the mineral 
salts. 

Synergists. — Pepsin, sodium chloride, vegetable acids, chlorhydric 
acid, etc. 

Dose. — Fifteen minims to 3 ss in water before or after meals, ac- 
cording to the conditions present. 

Physiological Action. — As lactic acid is a frequent constituent of 
the gastric juice, it has undoubtedly an important function in connec- 
tion with digestion. Used medicinally, it promotes the appetite and 
facilitates digestion. In large doses ( 3 j) it gives rise to epigastric 
pain, flatulence, and loss of appetite. As lactic acid is one of a series 
of homologous acids, containing butylactic, valerolactic, and leucic 
acids, it is not improbable that some of these may result from its oxi- 
dation when administered in excess. It probably combines with bases 
and forms lactates, for it displaces not only the volatile but some of 
the mineral acids from their combinations. Chemical investigations 
have indeed confirmed this, for, besides free lactic acid, lactates have 
been found in the gastric juice. It is not known definitely whether 
free lactic acid occurs in the blood in the healthy state, but it certainly 
does in some morbid conditions. According to Lehmann, lactates are 
rapidly converted into carbonates in the blood. Free lactic acid, as 
was long ago shown by Berzelius, is found in muscular fluid, and has 
also been detected in the spleen by Scherer. Although it is not always 
a constituent of normal urine, yet, when the supply of lactates to the 
blood is considerably beyond the oxidizing power of the blood, it has 
been found (Lehmann). Scherer has shown also that lactic acid is 
present in the exudates of puerperal fever. 

Lactic acid has the power to dissolve a considerable quantity of 
freshly-precipitated phosphate of lime. 

The suggestion made by Prout, of a relation between an excess of 
lactic acid in the blood and rheumatic inflammation, received a re- 
markable confirmation in the experiments of Richardson, who produced 
endocardial inflammation by injecting lactic acid into the peritoneal 
cavity of dogs. Further confirmation of this connection has been af- 
forded in the attacks of acute rheumatism which have occurred in sub- 
jects of diabetes treated by lactic acid. 

Therapy. — Solutions of lactic acid are of great utility as solvents 
of false membrane. Since the comparative demonstration of solvents 



LACTIC ACID. 93 

made by Bricheteau and Adrian, it has been employed successfully by 
Dr. Weber, of Darmstadt, and Dr. Dureau, in croup, applied by means 
of a pulverisateur in the strength of thirty to forty drops to the ounce 
(Waldenburg), and is also advocated by Morell Mackenzie and Len- 
nox Browne. The following is the formula used by Mackenzie at 
the London Throat Hospital : r£ Acidi lactici, 3 iijss ; aquae destil., 
§ x. M. This may be used in a spray-producer, or be applied on a 
mop to the affected part. It is unquestionably an excellent solvent of 
the exudation of diphtheria, as the author has frequently observed. 
It may be used also as a gargle when the exudation does not extend 
beyond the tonsils and the pillars of the fauces. For this purpose suffi- 
cient acid may be added to water to give a distinctly sour taste. As 
the application is free from danger, it may be used as often as every 
half -hour. When used in the form of spray, care must be had to pre- 
vent the acid hurting the eyes. 

It is chiefly in atonic dyspepsia that lactic acid is employed. In 
this condition lactic acid is, so to speak, a physiological remedy, for 
we supply it artificially because the stomach is unequal to the task 
of producing it. Generally, it is advisable to combine pepsin with it 
thus : r> Liq. pepsinae, 3 xij ; acidi lactici, 3 iv. M. A teaspoon- 
f ul three times a day after meals is a proper dose for an adult. In 
the apepsia of infants, characterized by the presence of undigested 
aliment in the discharges, this combination is an excellent remedy. 
If a marked degree of acidity exists, the acid should be omitted, or 
given before the milk, when it may prevent the excessive production 
of acid. In irritative dyspepsia, when the pain and suffering are due 
to slow and imperfect digestion, lactic acid will often give great relief, 
either alone or combined with pepsin. Cases of acidity and heartburn 
are often quickly relieved by lactic acid given before meals. When 
the presence of an excess of the phosphates, uric acid, and the urates, 
and of oxalate of lime, in the urine, is due to imperfect digestion and 
faulty assimilation, as is frequently the case, lactic acid is serviceable. 
Dr. Deecke advocates the use of lactic acid in chronic cystitis, as a 
means of arresting the ammoniacal decomposition of the urine, a con- 
dition in which he holds it to be very effective. 

Lactic acid has been used with varying success in the treatment of 
diabetes. The object to be gained is the prevention of sugar formation 
from the starchy and other elements of the food. Dr. Foster reports 
some cases apparently decidedly benefited, and Dr. Ogle gives an ac- 
count of two cases in which no good results were attained. Cases have 
been lately reported in which the patients were improved by the use of 
lactic acid, but on the whole the utility of this agent in diabetes must 
be held to be as yet subjudice. 

Disappointment in the use of lactic acid is frequently experienced 
from the poor quality of the drug. 



94 RESTORATIVE AGENTS. 

Authorities referred to above : 

Bricheteau, Dr. Felix. Bulletin General de Tlierapeutique, vol. lxxiv, p. 72. 

Butler, Dr. N. L. Treatment of Croup by Lactic-Acid Spray. The Practitioner, 
vol. vii. p. 189. 

Dureau, Dr. Bulletin General de Tlierapeutique, vol. lxxxiii, p. 45. 

Jaffe, Dr. Die Diphtheric. Schmidt's Jahrbucher der gesammten Medicin, vol. cxlix, 
p. 321. 

Ogle, Dr. John W., and Dr. Balthazer Foster. British Medical Journal. 

Lehmann, Prof. Dr. C. G. Physiological Chemistry, American edition, vol. i, p. 
85, et seq. 

Mackenzie, Dr. Morell. The Pharmacopoeia of the Hospital for Diseases of the 
TJiroat, London, 1872. 

Nothnagel, H. Handbuch der Arzneimittellehre, Berlin, 1870, p. 376. 

Ranke, Prof. Dr. J. Grundzuge der Physiologie des Menschcn, zweite Auflage, Leip- 
zig, 1872, p. 248. 

Waldenburg, Dr. L. Die locale Behandlung der Krankheitcn der Athmungsorgane, 
Berlin, 1872, p. 403. 

Mineral Acids. — Acidum Sulphuricum. — Sulphuric Acid. " A 
liquid composed of not less than 96 per cent of absolute sulphuric 
acid. A colorless, oily liquid, inodorous, and having strong acid and 
corrosive qualities. The specific gravity of sulphuric acid should be 
not less than 1*840. It is miscible in all proportions with water and 
alcohol, with the evolution of heat." (IT. S. P.) 

The official preparations into which sulphuric acid enters are aci- 
dum sulphuricum aromaticum and acidum sulphuricum dilutum. » 

Acidum Sulphuricum Dilutum. — Diluted sulphuric acid. " Sul- 
phuric acid, 1 part ; water, 9 parts. This contains 10 per cent of the 
official sulphuric acid, and has the specific gravity of 1*067 nearly." 
(IT. S. P.) Dose, ttiv — tuxxx, and should be well diluted with water 
when administered. 

Acidum Sulphuricum Aromaticum. — Aromatic sulphuric acid, or 
elixir of vitriol. " Sulphuric acid, 200 parts ; tincture of ginger, 
45 parts ; oil of cinnamon, 1 part ; and sufficient alcohol to make 
1,000 parts. The specific gravity should be 0*955." Dose, ttiv — 3 j, 
well diluted with water. 

Acidum Hydrochloricum. — Hydrochloric, formerly (U. S. Phar., 
1870) muriatic acid. " A liquid composed of 31*9 per cent of abso- 
lute hydrochloric acid and 61*8 per cent of water. It should have a 
specific gravity of 1*160. It is a fuming, colorless liquid, of a pun- 
gent, suffocating odor, and an intensely acid taste and reaction." The 
official preparations into which hydrochloric acid enters are acidum 
hydrochloricum dilutum, acidum nitrohydrochloricum, and acidum ni- 
trohydrochloricum dilutum. 

Acidum Hydrochloricum Dilutum. — Diluted hydrochloric acid. 
" Hydrochloric acid, 6 parts ; distilled water, 13 parts. This mixture 
contains 10 per cent of absolute hydrochloric acid, and has a specific 
gravity of 1*049." 



MINERAL ACIDS. 95 

Aciclum Nitrimm. — Nitric acid. " A colorless, fuming, very 
caustic and corrosive liquid, of a peculiar, somewhat suffocating odor, 
and a strongly acid reaction. Specific gravity, 1*420." The official 
preparations of nitric acid are acidum nitricum dilutum, acidum nitro- 
hydrochloricum, and acidum nitrohydrochloricum dilutum. 

Aciclum Nitricum Dilutum. — Diluted nitric acid. "Nitric acid, 
1 part ; distilled water, 6 parts. This solution should contain 10 per 
cent of absolute nitric acid, and have a specific gravity of 1*059. 
Dose, v\ ij — nt x, in sufficient water. 

Acidum Nitrohydrochloricum. — Nitrohydrochloric acid, also known 
as aqua regia. Nitric acid, 4 parts ; hydrochloric acid, 15 parts. Dose, 
nx ij — tu x, well diluted. 

Acidum Nitrohydrochloricum Dilutum. — Diluted nitrohydro- 
chloric acid. Nitric acid, 4 parts ; hydrochloric acid, 15 parts ; dis- 
tilled water, 76 parts. A colorless, faintly yellow liquid, odorless, or 
having a faint odor of chlorine, and a very acid taste and reaction. 
Dose, in, v — nx xx, in sufficient water. 

Acidum Phosphoricum. — Phosphoric acid. "A colorless liquid, 
odorless and of a strongly acid taste and reaction. Specific gravity, 
1-347." Dose, nt j — v\ x, well diluted. 

Acidum Phosphoricum Dilutum. — Phosphoric acid, 20 parts ; dis- 
tilled water, 80 parts. Dose, vi v — t\[ xx, in sufficient water. 

Antagonists and Incompatibles. — Alkalies and their carbon- 
ates, salts of lime and lead. 

Synergists. — Bitters and tonics in general. 

Physiological Actions. — By assisting digestion and by correcting 
an abnormal condition of the alimentary mucous membrane, acids 
directly contribute to the blood-forming process, and indirectly, through 
the blood, to the construction of tissue, and the bettering, in general, 
of the bodily condition. 

The mineral acids grouped above agree in the general qualities 
of their actions, but differ in some particulars. They attack the 
living tissues with great energy, abstract the water, and combine 
with the potash, soda, and lime bases. In virtue of this affinity for 
water and this power of combination with bases, they cause destruc- 
tion of tissue and are called escharotics. Some of them are more 
powerful than others : thus, sulphuric and phosphoric acids pen- 
etrate more deeply than the others. Nitric acid stains the skin yel- 
low ; sulphuric acid carbonizes or blackens. Hence in cases of acci- 
dent, or when these acids are used with criminal intent, it is very ob- 
vious at a glance which has been taken or given : nitric acid making a 
yellow stain of the face, lips, and mouth, and sulphuric carbonizing 
or blackening those parts. In the stomach they produce the same ef- 
fects. When concentrated, they destroy the mucous membrane of the 
mouth, epiglottis, oesophagus, and stomach. The systemic effects are 



96 RESTORATIVE AGENTS. 

those of the irritant and corrosive poisons. The appropriate rem- 
edies are chemical and mechanical : alkalies, magnesia, soda, lime, 
soap, to neutralize the acid ; and eggs, milk, oil, etc., to protect me- 
chanically the tissues. The depression of the powers of life which 
immediately follows the ingestion of a mineral acid should be treated 
by opium, nutrient and stimulating enemata, and the intra-venous in- 
jection of ammonia. 

The mineral acids, when administered in medicinal doses, must on 
reaching the stomach act in accordance with their chemical position. 
They will combine with the bases and form salts. Hydrochloric, and 
to a less degree phosphoric, aid digestion, acting as synergists to pep- 
sin, and contribute to the formation of peptones. Sulphuric unites with 
bases to form insoluble sulphates, and precipitates the albuminous sub- 
stances from their solution in the gastric juices ; hence this acid, 
although for a brief period it improves, soon disorders digestion. It 
is true of all the mineral acids that their long-continued use diminishes 
the production of acid gastric juice, and in this way after a time they 
cause the very troubles for the relief of which they were originally 
administered. An acid solution on one side of an animal membrane, 
and an alkaline solution on the other, is the condition most favorable 
to osmosis. Hence the introduction of an acid into the stomach with 
sufficient frequency and in sufficient quantity must impair the produc- 
tion of acid gastric juice. In practice this is found to be the case. 
The mineral acids are among the most diffusible substances known, 
and of these hydrochloric stands at the head. So much of these acids 
as does not enter into combination in the stomach diffuses quickly into 
the blood, and the salts which they form by combination with bases 
follow the laws of diffusion according to their class. The acids, es- 
pecially the hydrochloric, and next nitric, diminish the alkalinity of 
the blood, and in this way accomplish all that they are capable of 
doing as systemic remedies. 

Therapy. — Not much need be said of the use of the mineral acids 
in affections of the mouth and throat. Formerly they were much em- 
ployed in the treatment of mercurial and other forms of stomatitis, 
diphtheria, aphtha?, gangrene, etc. 

In using mineral acids in affections of the mouth, it should not be 
forgotten that they attack the enamel of the teeth. First, the animal 
matter adherent to the teeth is dissolved off, when the teeth are said to 
be " set on edge." The acid should be applied to the affected surface 
only, and the mouth should afterward be washed out with an alkaline 
lotion. Pure hydrochloric acid may be applied with a camel's-hair brush 
or on a bit of soft pine-wood to the gums in cases of sloughing from 
mercurial stomatitis, and to the ulcers of stomatitis materna, to syphi- 
litic mucous patches, and to those painful ulcers of the mouth which 
occur periodically in some subjects affected with a peculiar form of in- 



MINERAL ACIDS. 97 

digestion. In the case of ulcers having their origin in stomach-dis- 
order, the internal use of hydrochloric, nitric, or nitro-muriatic acid, is 
often extremely beneficial. 

The local use of hydrochloric acid in diphtheria, so strongly urged 
by Bretonneau, is now rarely employed, for it is well known that the 
diphtheritic exudation will rapidly extend over an inflamed surface pro- 
duced by the application of the acid, and the destruction of the exu- 
dation at one part does not prevent its extension and renewed forma- 
tion. 

Any of the mineral acids administered by the stomach should be 
well diluted, and to prevent injury to the teeth should be taken through 
a glass tube or a straw. The mouth should also be rinsed out after 
swallowing the acid. 

The mineral acids are highly useful in certain stomach-diseases. In 
atonic dyspepsia hydrochloric acid should be given after meals, or better, 
lactic acid. It is highly probable that hydrochloric acid is produced 
during digestion by the reaction between chloride of sodium and lactic 
acid. A combination of the acid with pepsin, as already suggested, is 
preferable in these cases of atonic dyspepsia. When, in consequence 
of faulty digestion, acetic, lactic, and butyric acids are produced in the 
stomach from the starchy, saccharine, and fatty constituents of the food, 
the acids given after meals add to the distress of the patient. 

To prevent the excessive formation of acid, whether due to the ac- 
tion of the gastric glands, or to abnormal fermentation of the starchy, 
saccharine, and fatty elements of the food, mineral acids are used with 
decided advantage, but they must be administered before meals. For 
this purpose, hydrochloric or phosphoric acid is to be preferred. The 
excessive production of acid is manifested by acid eructations, pyrosis, 
heartburn, and idcerative stomatitis. 

There is a form of indigestion characterized by eructations of offen- 
sive gas, painful digestion, a sallow complexion, and by the appearance 
of oxalate-of-lime crystals in the urine, and is accompanied by mental 
despondency. This state of things is relieved by the nitro-muriatic 
acid ; sometimes better by nitric. 

The experience of English physicians practicing in India has been 
favorable to the use of nitro-muriatic acid in chronic hepatic affections, 
and in dysentery and dropsy of hepatic origin. Acute diseases of the 
liver, and such chronic affections as cirrhosis and waxy degeneration, 
are not as a rule benefited by the mineral acids. Mucous duodenitis 
and catarrh of the gall-ducts accompanied by jaundice, and jaundice 
of malarial origin, are forms of hepatic disease in which nitro-muri- 
atic acid is serviceable. With the internal use of the acid should be 
conjoined the local use to the right hypochondrium of the acid bath. 
Three ounces of nitro-muriatic acid to a gallon of water is a suitable 
strength for the topical use in this way. The feet may be placed in the 
1 



98 RESTORATIVE AGENTS. 

bath, and the legs, arms, and abdomen may be alternately sponged, 
when the skin is torpid and its secretion defective. The temperature 
of the bath should be about 96° Fahr. (Martin). Another mode of 
making topical application of the acid bath is as follows : " Let a flan- 
nel roller of ten or twelve inches wide, and sufficient to encircle the 
body twice, be soaked in the fluid and then wrung so as to remain only 
damp. Apply this instantly to the body, covering it with a piece of 
oiled-silk to avoid damping the dress. It should be worn constantly, 
but should be changed, soaked, and wrung, morning and evening" 
(Squire). This is a very effective local application in the hepatic dis- 
orders mentioned above as amenable to treatment by the mineral acids, 
and is serviceable in the first stage of cirrhosis. Dr. Scott, of Bom- 
bay, ascribes to the acid bath the power to relieve the pain of hepatic 
colic, by causing the expulsion of the impacted calculus. 

The mineral acids are very effective remedies in the treatment of 
summer and colliquative diarrhoea. Crapulous diarrhoea and dysen- 
tery are not benefited by them. The indications for their use are these: 
painless, watery evacuations, of a light color, alkaline in reaction. 
Hope's mixture, which contains nitrous acid, has long been used with 
success in such cases. The formula is as follows : $ Acidi nitrosi, 3 j ; 
tincturae opii, gtt. xl ; aquae camphorae, 1 viij. S. : One fourth to be 
taken every three or four hours. A mixture of this kind may readily be 
extemporized, in which the relative proportion of the acid and opium 
may be arranged according to the indications of the case. Sulphuric 
acid is more decidedly astringent than nitric and muriatic, and is, 
therefore, as a rule, to be preferred in diarrhoea. Bence Jones places 
them as regards their actions thus: Hydrochloric more promotes diges- 
tion; nitric acid, secretion; and sulphuric, astringency. Nitric and nitro- 
hydrochloric are, according to this view, better suited to stomach and 
hepatic disorders characterized by deficient secretion, and sulphuric is 
more appropriate for the relief of a relaxed state of the mucous mem- 
brane. A combination of aromatic sulphuric acid with opium is one of 
the most effective remedies we possess in the treatment of summer diar- 
rhoea and cholera. Sulphuric acid may also be used with advantage in 
the treatment of dysentery, in combination with sulphate of magnesia. 
5 Magnesii sulphat., 1 j; acidi sulphur, dil., 3 ij; morphinae sulph., gr. j; 
aquae, 1 iv. M. S. : A tablespoonf ul every three or four hours. After the 
action of a saline laxative, Hope's mixture, or an extemporized prescrip- 
tion of a similar kind, may be used. When the mineral acids do not 
quickly improve the discharges and lessen their frequency, and when 
they increase the tormina and tenesmus, they should be suspended. In 
the treatment of cholera, dilute or aromatic sulphuric acid may be given 
frequently, well diluted, in full doses. Opium can be added at such 
intervals as may be indicated. MacCormac has found the acid to be a 
most valuable prophylactic against cholera attacks. It should be ad- 



MINERAL ACIDS. 99 

ministered with promptness when the preliminary diarrhoea is threat- 
ened. 

Mineral acids, especially the muriatic, are very serviceable in fevers. 
They were formerly classed as refrigerants, or cooling medicines, and 
were supposed to allay thirst and to diminish fever. Although these 
notions are no longer entertained, the acids are known to render an im- 
portant service in fevers. They increase secretion of the mucous mem- 
brane, and thus relieve the dryness of the tongue and fauces. As in 
fevers the gastric juice is deficient in acids, digestion is materially aided 
by their administration. In typhoid fever, the acids restrain somewhat 
the exhausting diarrhoea, increase the digestive power, and remove or 
diminish the dryness of the tongue. It is probable that they exert an 
influence on the composition of the blood, beyond the increased activity 
which they impart to the primary assimilation. Hydrochloric acid is 
preferable in the treatment of fevers. It may often be advantageously 
administered in beef -juice. 

In scarlet fever, hydrochloric acid is frequently combined with 
chlorate of potassa (producing euchlorine), but it is better adminis- 
tered alone in this disease. Besides the internal administration of 
the acid, it is often mixed with water and used as a gargle, or mixed 
with honey and applied with a brush to the throat. One part of acid 
to five parts of honey or ten of water is a strong enough solution for 
this purpose. In the other eruptive fevers, hydrochloric acid is serv- 
iceable to allay thirst, to increase digestion, and to obviate the tend- 
ency to adynamia in these diseases/*To children, the dilute hydro- 
chloric acid may be readily administered in lemonade or in sirup of 
lemons. 

There is no doubt of the value of the acids, especially the nitro- 
muriatic, in the treatment of constitutional syphilis. This remedy is 
not to be compared in efficiency with mercury and iodide of po- 
tassium, but in chronic cases saturated, so to speak, with these ap- 
proved remedies, in which syphilitic patches persistently reappear 
in the mouth, nitro- muriatic acid often renders important service. It 
is undoubtedly true that constitutional syphilis has been treated 
successfully by the acids alone, but a very rigidly abstemious dietary 
has been enforced in these cases. It has already been shown that 
the denutrition method is of itself sufficient in some cases to relieve 
the organism of constitutional infection. How much of the result 
is to be ascribed to the remedy, and how much to denutrition, is not 
clear. 

Nitric acid has been used with success in the treatment of inter- 
mittent fever by Hammond, Bailey, and others. In order to obtain a 
curative effect, it is necessary to give the acid in full doses every four 
or six hours. This acid is of great service, also, after an arrest of the 
paroxysms of intermittent by quinine, to remove the hepatic congestion 



100 RESTORATIVE AGENTS. 

and the changes in the glandular apparatus of the intestines induced 
by the fever-movement. It may be advantageously combined with 
the bitters, or used instead of the aromatic sulphuric acid in the prep- 
aration of the official infusum cinchonce flavce. 

The mineral acids have long been used with more or less advan- 
tage in the treatment of phthisis. Their utility obviously depends 
on the fact that they supply to the digestive fluids a material in 
which they are deficient in this disease. As Fenwick has shown, 
both pepsin and acid occur in quantity much less than normal in 
the gastric juice of phthisical subjects. The acid best suited for the 
treatment of the indigestion of phthisis is the official acidum mu- 
riaticum dilutum. 

Nitric acid is one of the numerous remedies used in whooping-cough. 
It is frequently successful in shortening the duration of the disease and 
moderating its violence ; but it acts much more beneficially after the 
subsidence of the catarrhal stage. It should be given well diluted 
in sweetened water. Chronic bronchitis and hoarseness produced by 
singing and by simple acute catarrh are relieved by ten-minim doses 
of dilute nitric acid. 

The mineral acids, especially the hydrochloric, have lately been 
proposed as remedies for acute rheumatism. The unquestionable util* 
ity of the tincture of the chloride of iron in rheumatism lends support 
to this practice. It is highly probable that the mineral acids check 
the formation of lactic acid inUhe blood. Whatever may be the na- 
ture of the action, good results irom the treatment have been reported 
(Dr. J. James Ridge). 

Some of the accidents due to lead are prevented, and relieved when 
they occur, by sulphuric acid. Sulphuric-acid lemonade is used by 
workmen in lead-factories to prevent lead-poisoning. This is supposed 
to act by forming the insoluble sulphate of lead. Dilute sulphuric 
acid is also effective in the treatment of lead-colic. The constipation 
due to lead is relieved by a combination of sulphuric acid and sulphate 
of magnesia, and the lead-cachexia is much benefited by a prescrip- 
tion of sulphate of quinine, sulphate of iron, and dilute sulphuric acid. 
The effects of lead on the nervous system are not removed by sul- 
phuric acid. 

Sulphuric acid is sometimes very effective in uterine hemorrhage. 
It has seemed to the author to be more useful in the case of haemor- 
rhage due to fibroid or polypus than the flow arising from other causes. 
Although sometimes prescribed for pulmonary hemorrhage, it is not 
equal to other remedies. In intestinal hemorrhage sulphuric acid acts 
directly in part, and is therefore serviceable. In purpura it sometimes 
acts happily. 

The aromatic sulphuric acid has long been used to check profuse 
sweating, especially the sweating of phthisis. It is certainly service- 



MINERAL ACIDS. 101 

able in this condition, but objectionable because of the ill effects of 
the acid on the function of digestion. If used at all, it should not in 
any case be long continued. 

Nitric and nitro-hydrochloric acids have also been used with ad- 
vantage in such diseases of the skin as lepra, impetigo, acne, erythema 
nodosum, and others, in which the skin-affection is symptomatic of 
imperfect digestion and assimilation. 

In certain morbid states of the urine, as the phosphatic diathesis, 
oxaluria, alkalinity of the urine from disease of the urinary mucous 
membrane, and. phosphatic calculus, the mineral acids render important 
service. In chronic cystitis and phosphatic deposits, a very weak solu- 
tion of nitric acid (gtt. j — 1 j) may be injected with advantage. In 
using such injections it is to be remembered that the bladder is ex- 
tremely intolerant, and hence they should be permitted to escape im- 
mediately. When uric acid is in excess in the urine from faulty diges- 
tion and assimilation, hydrochloric acid is often of great service : the 
excess of uric acid disappears because the foods are more perfectly 
prepared for admission into the blood. 

Local or Topical Uses of the Mineral Acids. — Some allusions 
have been made to the local application of muriatic acid in diseases of 
the throat and of the acid bath in hepatic affections. It will not be 
necesary to recapitulate on these points. 

Nitric acid is one of the most efficient escharotics for the destruc- 
tion of specific or unhealthy ulcers. It is the most frequently used 
caustic for the destruction of chancroid, sloughing or phagedenic 
chancre. A glass rod or bit of pine is dipped into the acid and ap- 
plied, care being taken to penetrate to all the sinuosities of the sore. 
The surrounding healthy tissue may be protected from injury by the 
previous application of oil, and, when the acid has sufficiently pene- 
trated, its further action may be arrested by some alkaline wash. A 
water-dressing, or spirit and water, or dilute tincture of benzoin, or 
some similar application, may be afterward applied to the sore. Ordi- 
nary indurated chancre does not require escharotic applications. Hos- 
pital gangrene, or a gangrenous condition of wounds, injuries, or 
ulcers, is similarly treated with advantage, and probably no form of 
caustic is more desirable than nitric acid for these purposes. Ordinary 
torpid and ill-conditioned ulcers are improved and put in the way of 
healing by frequent washing with a weak lotion of nitric acid ( J j — 
Oj). The same solution will remove mucous patches and condylomata, 
and will often check the bleeding from haemorrhoids. 

Nitric acid is one of the means employed for the removal of hem- 
orrhoids. It is not effective, however, against all forms. Large 
haemorrhoids are much better treated by the ligature, galvano-caustic 
loop, or other radical measures. The so-called "strawberry-pile," a 
small hemorrhoid of red color, which consists of a congeries of arte- 



102 RESTORATIVE AGENTS. 

rial twigs and which bleeds freely, can be effectually destroyed by 
nitric acid. The pile should be exposed, usually through a speculum, 
and the strong nitric acid be applied on a pine stick freely, followed 
by an abundant application of olive-oil to prevent the extension of the 
escharotic action to the surrounding parts. Small, superficial ncevi 
are treated successfully in the same way. 

Sulphuric acid penetrates more deeply than nitric, and its escha- 
rotic action is not so easily limited ; hence, it is not so frequently em- 
ployed for the destruction of sloughing and ill-conditioned ulcers. It 
is sometimes used in the form of Ricord's paste to chancres, sloughing 
or phagedenic. The paste is made by the addition of sufficient char- 
coal to strong sulphuric acid to give it the proper consistence. This 
is spread on a piece of muslin of a size equal to the sore, and is allowed 
to remain on until an eschar is produced, when an ordinary poultice 
may be applied. 

A favorite liniment of Sir Benjamin Brodie for counter-irritation 
of diseased joints is made by the addition of sulphuric acid to olive-oil 
( 3 j of the acid, § iv of olive-oil). 

A general bath in, or sponging the body with, a solution of nitro- 
muriatic acid — one ounce to a gallon — is very serviceable in the case 
of cachectic children who present these symptoms : a dry and wrinkled 
skin, sallow complexion, capricious appetite with a taste for dirt-eat- 
ing, and whitish, pasty motions. Applying to the surface of the body 
an acid solution must affect the constitution of the blood, for an acid 
solution on one side of an animal membrane and an alkaline fluid on 
the other are the conditions most favorable to osmosis. 

Lately, Dr. Lombe Atthill, of Dublin, has called attention to the 
"use of nitric acid in the treatment of uterine disease." He applies 
the fuming nitric acid to the interior of the uterine cavity after pre- 
vious dilatation with sponge or laminaria tents. In order to protect the 
cervix and cervical canal he introduces an intra-uterine speculum with 
expansive blades. The cavity is first mopped out and dried with cot- 
ton ; then a probe, wrapped with cotton, is dipped in fuming nitric 
acid and applied thoroughly to the mucous membrane. This practice 
is very effective in the treatment of intra-mural fibroids and fungous 
granulations, to restrain hemorrhage, and after the removal of polypi. 
He almost invariably employs nitric acid in the treatment of granular 
cervicitis and endo- cervicitis, "with the best results." When decided 
tenderness of the uterus exists, he advises that this be first removed by 
suitable measures. 

Authorities referred to above : 

Atthill, Dr. Lombe. Obstetrical Journal of Great Britain and Ireland, June, 1873. 
Bretonneau. Des Inflammations Speciales du Tissu Muqueux, et en particulier de la 
Diphtherite, Paris, 1826, p. 242, et seq. 

Fox, Dr. Wilson. The Diseases of the Stomach, Macmillan & Co., 1872, p. 140. 



OILS AND FATS. 103 

Gubler, Dr. Adolph. Commentaires Therapeutiques du Codex Medicamentarius, Paris, 
1868, p. 464. 

Mackenzie, Dr. Morell. Pharmacopoeia of the Throat Hospital, p. 35. 

Martin, Sir Ranald. London Lancet, December 9, 1865. 

Nothnagel, Dr. Hermann. Handbuch der Arzneimittellehre, Berlin, 1870, p. 3*78, 
et seq. 

Ridge, Dr. J. James. The Medical Times and Gazette, vol. ii, 18*71. 

Ringer, Dr. Sidney. A Handbook of Therapeutics, third edition, p. 97, et seq. 

Squire. Companion to the British Pharmacopoeia, 1871, p. 12. 

OILS AND FATS.. 

Adeps. — Lard. Saindoux, Fr. ; Schweineschmah, Ger. — Below the 
temperature of 86° Fahr. a soft solid. 

Adeps Benzoinatus. — Benzoinated lard. 

Sevum. — Suet. Suif de mouton, Fr.; Schopsentalg, Ger. The pre- 
pared suet of ovis aries. 

_ ■ x Oleum, Amygdalae expressum. — Almond-oil. Huile d^amandes, Fr. ; 
Mandelnol, Ger. The fixed oil obtained from the kernel of the fruit 
of the Amygdalus communis. 

Oleum Theobromce. — Cacao-butter. Beurre de cacao, Fr. ; Cacao- 
butter, Ger. The concrete oil of the kernels of the fruit of Tlieobroma 
cacao. 

Oleum Lini. — Flaxseed-oil. Huile delin,Fr.-, Leinbl, Ger. The 
fixed oil obtained from Linum usitatissimum. 

Oleum Olivai. — Olive or sweet oil. Huile d ^ olive, Fr.; Olivenol, 
Ger. The fixed oil obtained from the fruit of Olea Earopma. 

Oleum Gossypii Seminis. — Cotton-seed oil. A fixed oil expressed 
from the seed of Gossypium herbaceum, and subsequently purified. 
(Used in the preparation of linimentum ammonia? ; linimentum calcis ; 
liniment um camphorse ; linimentum plumbi subacetatis.) 

Composition. — The above-mentioned oils and fats differ in the 
quantity of olein, stearin, and margarin which they respectively con- 
tain, and hence differ in physical qualities. Lard is composed of 38 
per cent of stearin and margarin and 62 per cent of olein, and olive- 
oil of 72 per cent of olein and 28 per cent of margarin. The more 
solid fats, as suet, contain much stearin. These neutral fats are, 
chemically, combinations of an acid (stearic, palmitic, margaric, oleic) 
with a base, glycerin. The olein of linseed-oil appears to differ from 
ordinary olein by furnishing a different acid — linoleic — when saponi- 
fied. 

Oleum morrhuai. — Cod-liver oil. Huile de morue, Fr. ; JLeberthran, 
Ger. The fixed oil obtained from the fresh livers of Gadus morrhua 
and other species of Gadus. 

Composition. — Cod-liver oil contains a peculiar principle, gaduin, 
and yields, by distillation with ammonia, propylamin. It also differs 
from the fats and oils above described in containing various biliary 



104 RESTORATIVE AGENTS. 

principles and traces of iodine, bromine, phosphorus, sulphuric and 
phosphoric acids, lime, magnesia, soda, and iron. It agrees with the 
other oils in being composed for the most part of olein and margarin. 
It is the latter constituent which gives the white cloudiness of cod-liver 
oil in cold weather, and which is, by the " British Pharmacopoeia," di- 
rected to be separated by artificial cooling. According to Winkler, 
cod-liver oil does not yield glycerin, but oxide of propyl, when sa- 
ponified. 

There are three varieties of oil, due, not to differences in composi- 
tion, but to modes of preparation : the pale, the light-brown, and the 
dark oil. The pale oil is freest from the products of decomposition 
and empyreuma, and is the best for internal administration. 

In order to obtain more positive therapeutical results, certain me- 
dicinal substances are frequently added artificially to the cod-liver oils 
of commerce. Iodine, bromine, phosphorus, and iron, are thus added. 
Not only are such compounds bad, chemically considered, but the addi- 
tion of such ingredients gives great opportunities for sophistication, 
and impure brown and other fish-oils may be substituted for the pure 
cod-liver oil. 

It has been supposed that any oil or fat, even glycerin, may be 
used in place of cod-liver oil, and cream has been prescribed in this 
belief. Linseed-oil has been considered to have some special efficacy in 
wasting diseases, more particularly in phthisis, because of the large 
amount of vegetable albumen which it contains. These notions are 
erroneous. Cod-liver oil has special therapeutical virtues because it 
contains gaduin, propylamin, the constituents of bile, iodine, phos- 
phorus, bromine, etc., in addition to the ordinary ingredients of an 
animal fat. 

Physiological Actions. — An oil or fat applied by friction to the 
epidermis will disappear, and, as a positive gain may thus accrue, it is 
reasonable to suppose that not only absorption, but assimilation, also, 
has taken place. 

Pat plays an important part in the metamorphosis of animal fluids. 
As was long since shown by Lehmann, a small quantity of fat is essen- 
tial to the digestion of nitrogenous articles of food. Cod-liver oil, as 
well as other oils, when taken in the proper quantity, has the power to 
facilitate gastric digestion, and therefore promotes the appetite. Oil 
is a very important material in intestinal digestion — constitutes the 
molecular basis of the chyle, which consists chiefly of finely-divided 
fatty matter, each globule of fat being surrounded by a thin layer of 
albumen. The fat taken in with the food undergoes the emulsionizing 
process, chiefly in the small intestine, and by the aid of the pancreatic 
and biliary secretions. Cod-liver oil is, above all other fats, adapted 
to form the molecular basis of the chyle. All fats do not penetrate 
into the veins and lacteals with the same facility, and the presence of 



OILS AND FATS. 105 

certain substances is necessary to the process. Fats are not crystal- 
loidal but colloidal substances, and have, therefore, but a feeble power 
of osmosis ; but, notwithstanding this fact, the blood of the portal 
vein is much richer in fat than the blood of the arteries and systemic 
veins. The diffusion of fats is accomplished by the action of the bile. 
It was long since shown, by Wistinghausen, that in capillary tubes 
moistened by bile, oil will rise much higher than in tubes not so moist- 
ened, or when moistened with water or a saline solution. He also 
showed that oil will pass through membrane saturated with bile much 
more readily than through similar membrane saturated with water. 
It has been ascertained that, in dogs with biliary fistulse, the amount 
of fat in the chyle is much below the normal, and in the faeces much 
greater than normal (Day). Hence it must be concluded that the 
presence of bile is necessary to the absorption of fats, and that cod- 
liver oil must be peculiarly adapted to form the molecular basis of the 
chyle. It is for these reasons that, during a course of cod-liver oil, 
the body-weight is increased, the red blood-globules become more nu- 
merous, and a greater amount of fat is deposited in the tissues. It 
promotes the constructive metamorphosis. The important role per- 
formed by the oils and fats in the organism is shown by a variety of 
considerations. Wherever tissue-changes, physiological or pathologi- 
cal, are taking place, fat accumulates and enters largely into the for- 
mation of the resulting products. Newly-formed plasma contains 
much free fat, and all plastic exudations more than the non-plastic 
(Lehmann). Fat is the most abundant constituent of pus. 

Food is intended ultimately for two objects : first, to build up the 
tissues in the growing state and to reconstruct the tissues wasted by 
use ; second, to supply force, nervous, muscular, and digestive, to the 
different parts of the organism requiring it. The part performed by 
the fats is important as regards both objects. As already stated, they 
are essential to the construction of tissue ; modern researches have 
shown that they have a necessary office in the evolution of force. The 
well-known experiment of Fick and Wislicenus demonstrated that, on 
a diet of hydrocarbons, great muscular effort can be undergone with 
but little destruction of muscular tissue, and without increased urea- 
discharge. Turkish porters, who are remarkable for their great mus- 
cular strength and endurance, live on a diet composed of fat and rice. 
The acrobats of Japan, who live on a similar diet, grow to an enormous 
size, and accomplish feats of strength and agility to which the athletes 
of Western nations are hardly equal. 

If a muscle is made to contract under a bell-jar, an extraordinary 
evolution of carbonic-acid gas takes place, just as in violent muscular 
exercise the amount of carbonic-acid gas exhaled from the lungs is 
increased. 

Therapy. — Oils and fats are used by inunction in the treatment of 



106 RESTORATIVE AGENTS. 

the scaly skin-diseases. In this case, the normal amount of oil in the 
skin being deficient, it is supplied artificially. 

Inunctions of oil or fat promote constructive metamorphosis in such 
chronic wasting diseases as phthisis, scrofula, chronic dysentery, etc. 
The best oil for this purpose is cod-liver oil, but, as it stains the skin 
yellow and has a disagreeable odor, it is often strongly objected to. 
Sevum or suet may be used, and may be perfumed to the taste of the 
patient. The best time for practicing the inunctions is just before re- 
tiring. A warm bath should first be taken, and then from one to two 
ounces may be rubbed into the skin. A thick night-garment should 
be put on to prevent injury to the bedding. 

Badly -nourished infants, rickety, or scrofulous, or suffering from 
chronic intestinal disorders, who have a dry and scaly skin, are often 
materially benefited by the tepid or warm bath, followed by inunctions 
of lard, suet, or almond-oil. Chlorotic girls, with or without disor- 
ders of menstruation, are improved in condition by the same means. 
Spare women, who wish to gain flesh and roundness of form, may have 
their wish gratified by warm baths and inunctions of oil. The im- 
provement which results from this practice is partly due to the general 
gain in bodily nutrition. 

Rubeola, scarlatina, roseola, erysipelas, and other febrile diseases, 
are benefited by oil inunctions. These applications are grateful to the 
patient ; they allay the burning heat of the skin, and in this way di- 
minish restlessness and excitement. It is said that inunctions of oil 
reduce the temperature, but the decline in fever-heat is probably the 
result of the calmative influence which these applications have over 
one of the chief sources of distress. Inunctions of oil have a special 
utility in the desquamative stage of scarlet fever. It is the author's 
observation that inunctions of oil are serviceable in fevers generally, 
when there is much heat of skin and high temperature, with restless- 
ness. Cocoa-butter is the most elegant of these preparations for ex- 
ternal use. In the infectious diseases, a little carbolic acid may be 
added to the inunction oil or fat, with the view of destroying disease- 
germs. 

Those who experience frequent catarrhal attacks, and take cold on 
slight exposure, may have their susceptibility diminished by a daily 
application of oil to the whole surface of the body. 

In many maladies, the patients experience a notable distaste for 
fatty food in any form. This is especially the case with scrofulous 
and phthisical subjects, and, as fat in some form is necessary to di- 
gestion, assimilation, and heat-producing, it is obvious that by the use 
of cod-liver oil an essential element of nutrition may be supplied in the 
best form. In cases in which there exists a condition of faulty as- 
similation of fats, cod-liver oil, by reason of the fact that it contains 
in intimate association the bile elements, is especially adapted to form 



OILS AND FATS. 107 

the molecular basis of the chyle. In scrofula, rickets, and other dis- 
orders of the nutritive functions belonging to this group, cod-liver oil 
is the best agent for promoting constructive metamorphosis. 

After scarlet fever in many children, especially in those with stru- 
mous diathesis, there occur discharges from the nose and ears, feeble 
digestion, and general emaciation. These sequelce of scarlet fever are 
best removed by the internal use of cod-liver oil. 

As a remedy in phthisis, cod-liver oil holds the first place, but it is 
not adapted to all forms and all stages of that disease. It is especially 
a remedy for the chronic forms of phthisis— -fibroid lung and chronic 
tuberculosis — and is not serviceable in caseous pneumonia and acute 
phthisis. It is more useful in the chronic forms of phthisis because 
these afford the time and opportunity to reconstruct the tissues of the 
body — to build up the tissues from the molecular basis of the chyle. 
Cod-liver oil is not well borne when there is much fever, and can not 
be well assimilated when the stomach has undergone the alterations 
which belong to acute inflammatory affections. This remedy is too 
often prescribed without any reference to the condition of the pa- 
tient's digestive functions. The power of the stomach and intestines 
to digest fat is limited, and, if the quantity which can be disposed of 
is exceeded, the patient is incommoded. Rarely is it proper to pre- 
scribe more than a teaspoonful three times a day, and few patients 
can digest a tablespoonful. As the secretion of gastric juice, bile, and 
pancreatic juice, takes place most abundantly during the digestion of 
food, the time for the administration of oil in phthisical cases is after 
eating. When it is not well borne, the digestion and assimilation of 
the oil may be aided by combining it with liquor potassae, lime-water, 
the compound tincture of gentian, tincture of nux vomica, or strychnine, 
or other correctives according to the indications in individual cases. 
When the oil is not well digested — although stomach disorder may 
not have occurred — and it is seen to float on the stools, it may be com- 
bined with ether, since Bernard has demonstrated that ether increases 
the production of pancreatic fluid. 

If continued for a sufficient length of time, cod-liver oil is of the 
greatest service in chronic bronchitis and emphysema. It should be 
given in the same way and under the same conditions as in phthisis. 

Chronic rheumatism and rheumatic arthritis, maladies for the re- 
lief of which cod-liver oil was first prescribed, when occurring under 
bad hygienic influences in cachectic subjects, may be much relieved 
by this agent. In addition to the internal use of the oil, it may be 
applied with advantage locally to the affected joints. This combined 
use of the oil, systemically and by local inunction, is to be commended 
in the so-called rheumatic gout with deposits about the joints. On the 
same principle, cod-liver oil is beneficial in cases of strumous syno- 
vitis, caries, and necrosis of bone dependent on a constitutional state. 



108 RESTORATIVE AGENTS. 

It does not have, it must be admitted, any direct influence over these 
morbid processes ; but it enters most usefully into constructive tissue- 
metamorphosis. 

As a reconstituent, cod-liver oil is a very useful remedy in certain 
chronic affections of the brain and nervous system. One of the most 
common conditions with which we have to deal in middle and ad- 
vanced life, and also one of the most important as regards the integ- 
rity of the brain, is atheroma of the arteries. This condition is rep- 
resented by increased hardness of the radial pulse, the arcus senilis, 
irregular action of the heart, giddiness, vertigo, partial loss of vision, 
and failure of the memory and other intellectual faculties. Used to 
obviate these degenerative changes, and to prevent failure in the nu- 
trition of the brain, we have in cod-liver oil a remedy of real value. 
It should be given in small quantity, and continued for a long time. 
As a phosphorized fat plays an important part in the structure and 
functions of the cerebral tissues, we may imitate the processes of Na- 
ture and administer the phosphates, the hypophosphites, or the lacto- 
phosphate of lime, in combination with cod-liver oil. The author has 
seen excellent results from such a combined use of these agents. Dr. 
Anstie much insists on the use of fats, especially cod-liver oil, as a 
part of the diet of those suffering from neuralgia, paralysis agitans, 
epilepsy, mercurial tremor, and chorea. Dr. Radcliffe had previously 
pointed out the utility of fats and oils in the same affections, and all 
practical physicians familiar with the subject are now pretty well 
agreed as to the value of this practice. The special indications for 
cod-liver oil in these affections are faulty assimilation and a low con- 
dition of the nutritive functions. Fats and oils are, of course, contra- 
indicated in these nervous disorders when they occur in plethoric and 
overfed subjects, but such a state of things is exceptional. 

In diseases of the skin of strumous origin, cod-liver oil is, as Dr. 
Tilbury Fox remarks, " our sheet-anchor." Among these diseases are 
lupus, ecthyma, psoriasis, scleroderma, etc. The constitutional state 
requiring cod-liver oil is a lowered condition of the assimilative func- 
tions dependent on the strumous cachexia. The local use of the oil is 
certainly advantageous in these cases. Dr. Hughes Bennett strongly 
recommends the free application of the oil to favus and eczema im- 
petiginodes. 

The condition of debility and faulty assimilation which results 
from the prolonged treatment of syphilis with mercury and iodine is 
frequently remarkably improved by cod-liver oil. The syphilodermata, 
when occurring in cachectic subjects, are benefited by a persistent use 
of the same remedy. "With the internal use of the oil may be con- 
joined inunctions. These are especially beneficial in the squamoe of 
syphilitic origin. 

Mode of Administration of Cod-Liver Oil. — As cod-liver oil is 



OILS AND FATS. 109 

extremely repugnant to many patients, it is desirable to prescribe it in 
as agreeable a form as possible. Washing out the mouth with raw 
whisky or brandy so far blunts the sensibility of the nerves as to per- 
mit the oil to be swallowed without difficulty as regards its taste. 
Quickly stirred up in a hot whisky-punch, it may be swallowed with- 
out appreciation of the taste of the oil. It may be taken on beer, the 
oil covered with the foam, and carefully prevented touching the glass. 
A wine-glass may be thoroughly moistened with ale or beer, and the 
dose of oil just enveloped in the beer, when it may be tossed into the 
throat without perceiving the taste of the oil ; or the oil may be taken 
in sufficient lemon-juice in the same way. It may also be taken in 
black coffee. A very good disguise is that of Carlo Paresi, by which 
it is made to have the odor and taste of coffee. To 400 parts of cod- 
liver oil are added 10 parts of animal charcoal and 20 parts of ground 
roasted coffee. The mixture is digested in a water-bath at a tempera- 
ture of 50° to 60° C, and after standing three days is filtered and put 
in well-stoppered bottles. It is said that 10 drops of chloroform to 
100 grammes of the oil will render it palatable. One part of essential 
oil of eucalyptus to 100 parts of pale oil makes a mixture in which the 
odor and taste of the oil are entirely extinguished. Two drachms of 
cod-liver oil may be mixed with a drachm each of compound spirits of 
lavender and brandy. Emulsions of cod-liver oil are now prepared 
with glycerin and yolks of eggs, and suitably flavored. The various 
emulsions with lime are also much prescribed. Cod-liver oil saponified 
by lime has been brought forward by Prof. Yan den Court, of Brus- 
sels, as a remedy of especial efficacy in phthisis. Lastly, cod-liver oil 
has been used instead of lard or butter in the preparation of rolls, 
which are readily eaten by children. The addition of ether to cod- 
liver oil promotes its digestion. Bernard long ago made the observa- 
tion that ether stimulates the pancreas and increases its secretion, thus 
contributing to the emulsionizing of the fats. The combination of ether 
and cod-liver oil has been especially urged by Dr. B. Foster. The 
committee of the New York Therapeutical Society report that the ad- 
dition of fifteen minims of ether to each half-ounce of oil enables the 
patient to take it, if it had previously disagreed. 

Authorities referred to : 

Anstie, Dr. Francis E. Neuralgia and the Diseases that resemble it, Macmillan & Co., 
London, 18*71. 

Bennett, Dr. J. Hughes. Oleum Jccoris Aselli as a llierapeutic Agent in Certain 
Forms of Gout, Rheumatism, and Scrofula, London, 1841. 

Day, Dr. George E. Chemistry in its Relation to Physiology and Medicine, London, 
1860, p.. 174. 

Flint, Dr. Austin, Jr. Tlie Physiology of Man, vol. ii, p. 372, New York, 1873. 

Gubler, Dr. Adolph. Commentaires Therapeutiques, etc., Paris, 1868, p. 156. 

Lehmann, Prof. C. G. Physiological Chemistry, Philadelphia, 1855, vol. i, p. 221, 
et seq. 



110 RESTORATIVE AGENTS. 

Nothnagel, Dr. Hermann. Bandbuch der Arzneimittel, Berlin, 1870, p. 661, et seq. 

Ranke, Prof. Dr. Johannes. Grundziige der Physiologie des Menschen, Leipzig, 1872, 
p. 289. 

Ringer, Dr. Sidney. Handbook of Therapeutics, p. 247. 

Simon, Dr. Franz. Animal Chemistry, Syd. Soc, vol. i, p. 206. 

Trousseau et Pidoux. Traite de Therapeutique et de Matiere Medicale, huitienie edi- 
tion, vol. i, p. 304. 

Williams, Dr. J. C. B. and Dr. Theodore. Consumption. 

PHOSPHORUS AND SOME OF ITS COMPOUNDS. 

Phosphorus. — Phosphore, Fr. ; Phosphor, Ger. A translucent, 
nearly colorless solid, resembling wax, without taste, but having a pe- 
culiar smell. Its specific gravity is 1*8. 

Oleum Phosphoratum. — Phosphorated oil. Prepared by dissolv- 
ing phosphorus in ether and almond-oil. One part of phosphorus to 
100 parts of the menstruum. Dose, Hii — tt^v. 

Pilulce Phosphori. — Phosphorus pills. Each pill contains about 
yi-g- grain. Phosphorus is dissolved in chloroform, and then mixed 
with powdered althea and acacia, glycerin, and water. The pills are 
coated with balsam of tolu. 

Tinctura Phozphori (not official). — Phosphorus, one grain ; absolute 
alcohol, five drachms ; glycerin, one ounce and a half ; spirit of wine, 
two drachms ; spirit of peppermint, two scruples. "Dissolve the 
phosphorus in the alcohol with a little heat ; at the same time warm the 
spirit and glycerin together. Mix the two solutions while hot, and add 
the spirit of peppermint on cooling. Dose, one half to one drachm." 

Tinctura Phosphori JEtherealis (not official). — Solution of phos- 
phorus in ether. Dose, five to ten drops in sirup. A solution of phos- 
phorus in chloroform, or bisulphide of carbon, may also be prepared 
for internal administration. Pills of phosphorus may be extempo- 
raneously made by mixing the bisulphide of carbon solution with 
some inert powder. The evaporation of the bisulphide leaves the 
phosphorus in a finely-divided state intimately incorporated with the 
powder. 

Zinci Phosphidum. — Phosphide of zinc. Dose, one twentieth to 
one tenth of a grain. It is best administered in pill-form made with 
conserve of roses. 

Synergists. — Oils and fats favor the absorption of phosphorus, 
and should never, therefore, be employed in cases of poisoning by 
this agent. Arsenic, and in a feeble degree sulphur, are synergistic. 

Antagonists. — The chief chemical antidotes to phosphorus are 
hydrated magnesia, lime-water, powdered charcoal, and sulphate of 
copper. To this list must be added turpentine of a certain kind. 
Phosphorus is now frequently taken in the form of matches, the par- 
ticles of which do not readily dissolve in the stomach and intestinal 
juices. When pure phosphorus, in the sticks or cylinders in which it 



PHOSPHORUS. HI 

occurs in commerce, is swallowed, large masses may remain imbedded 
in the folds of mucous membrane, or, escaping solution, descend with 
the other contents of the canal. Considerable time may thus elapse 
from the ingestion of the poison until its action begins. Emetics, 
therefore, assume a high degree of importance, and the most service- 
able emetic is sulphate of copper, which is at the same time a chemical 
antidote (Eulenburg and Guttmann). Bamberger has shown that 
phosphorus reduces sulphate of copper to the metallic state, the first 
step in the process being the formation of phosphide of copper, and 
that the masses of phosphorus are surrounded by a layer of copper, 
preventing its evaporation. He therefore advises that an emetic dose 
of sulphate of copper be first administered. Emesis may be facilitated 
by giving hydrated magnesia, diffused in a quantity of tepid water. 
As catharsis is next in importance, the bowels should be thoroughly 
evacuated. After the emetic dose of sulphate of copper has acted 
efficiently, this antidote should be given in small doses as frequently 
as possible — about one twelfth of a grain every twenty minutes. As 
the irritability of the stomach may prevent sufficient retention of the 
sulphate, the carbonate of copper has been proposed as a substitute, 
although Eulenburg and Landois, in their experiments on animals, have 
been unable, by the exhibition of the latter, to prevent death in cases 
of phosphorus-poisoning. 

Unquestionably the most important chemical antidote is turpentine, 
the French acid turpentine, especially. Letheby was the first to note 
that the vapor of turpentine prevented the toxic action of the vapor 
of phosphorus, and that workmen employed in the match-factory at 
Stafford, who were protected by vials of turpentine worn about the 
neck, escaped necrosis of the maxillary bones and other deleterious 
effects. Dr. P. C. Andant next published cases indicating the anti- 
dotal power of turpentine, and M. Personne submitted the subject to 
experimental demonstration and confirmed the observations of Andant. 
As turpentine destroys the luminosity in the dark and arrests the es- 
cape of the vapor of phosphorus, M. Personne infers that it acts simi- 
larly as an antidote, that is, prevents the combustion of phosphorus in 
the blood and the consequent consumption of the oxygen. The author 
has collected forty-six cases of poisoning by phosphorus, in which tur- 
pentine was employed as the antidote, and of this number but four 
were unsuccessful (Kohler, Sorbets, Laboulbene, Schimpff, Lichten- 
stein, Rommeleare, Berthold, etc.). Rectified oil of turpentine is not 
antidotal. The acid French oil is the preparation which has been 
used with success. The experiments of Yetter on animals fully con- 
firm the results of clinical experience, for he found that, while the 
rectified oil of turpentine had no effect, the crude, acid, French tur- 
pentine was very efficient as an antidote. The action of the crude 
turpentine is a process of oxidation and combination by which phos- 



112 RESTORATIVE AGENTS. 

phorus is converted into phosphoro-terebinthinic acid — a spermaceti- 
like substance, without poisonous or irritating qualities, which is elim- 
inated by the kidneys, the urine having a camphoraceous instead of 
the violet odor due to turpentine itself. Although the crude French 
oil is to be preferred, it is probable that our common oil of turpentine, 
exposed to the air, will develop antidotal power, by absorbing and 
ozonizing oxygen. The vapor of turpentine acts in the same manner 
on the vapor of phosphorus. The change in the effects of phosphorus 
acted on by turpentine has been thoroughly worked out. Adminis- 
tered to dogs, from one to fifteen grains, this substance excited no 
nausea, did not impair the appetite, caused no change in the tissues, 
and was eliminated harmlessly by the kidneys. 

To sum up : In the treatment of poisoning by phosphorus, in any 
of the forms in which it is introduced into the stomach, an emetic 
of sulphate of copper should be promptly employed, and the bowels 
should be moved by hydrated magnesia. When the stomach is emp- 
tied, small doses of sulphate of copper may be administered, but pref- 
erably turpentine, which should be given as rapidly as possible in an 
emulsion of gum, carefully avoiding oil. To counteract the cardiac 
and general systemic depression, opium will become necessary. If 
phosphorus has entered the blood despite the use of the appropriate 
antidotes, and much injury to its corpuscular elements has resulted, 
transfusion can be employed with considerable confidence, since Jur- 
gensen has succeeded in several instances in saving life by this ex- 
pedient. Direct transfusion of human blood, with or without previous 
withdrawal of some portion of the damaged blood, is the proper pro- 
cedure. 

Physiological Actions. — The vapor of phosphorus is highly irri- 
tating to the conjunctiva and to the broncho-pulmonary mucous mem- 
brane. If caries of the teeth exist, necrosis of the maxillary bones 
may be induced by the vapor ; but it is doubtful whether, as has been 
aflirrned, such necrosis may occur when the teeth are perfectly sound. 
There is an obvious distinction between the local effects of the vapor 
of phosphorus and the disease of the osseous system, the result of the 
constitutional impression of this agent. 

In ordinary medicinal doses, phosphorus gives rise to a sense of 
warmth at the epigastrium, but, if the dose be large, decided heat and 
even burning are experienced, and tenderness of the epigastrium re- 
mains. Prolonged administration of full doses will excite considerable 
gastric disturbance, and a catarrhal state of the mucous membrane. In 
the process of the oxidation of phosphorus, hydrogen is evolved, which 
in its nascent state readily combines with a portion of phosphorus, 
forming phosphide of hydrogen, eructations of which constitute one of 
the disagreeable features in the administration of this remedy. The 
action of the heart becomes more frequent, and the cutaneous circu- 



PHOSPHORUS. 113 

lation, especially, more rapid ; the body temperature rises somewhat ; 
the mental activity and the muscular power increase ; the menstrual 
flow grows more abundant, and in males aphrodisiac effects are experi- 
enced, and the urine and sweat are more abundantly excreted. Phos- 
phorus promotes the constructive metamorphosis ; it increases the 
activity of the organs of vegetative life, and is a natural excitant of 
the functions of animal life ; it enters largely into the formation of 
tissues, and is a necessary element in the phosphorized fat which holds 
an important position in the composition of the cerebral matter. The 
administration of phosphorus increases the excretion of urinary phos- 
phates. 

The effects of phosphorus in toxic doses have been elaborately stud- 
ied, both in fatal cases of poisoning, occurring in man, and by experi- 
ments on animals. The form in which it is swallowed affects the rate 
at which the action occurs. If taken in solution in oil, in ether, or in 
the paste used as a vermin-destroyer, the toxic symptoms appear more 
promptly than if match-heads or ordinary phosphorus has been swal- 
lowed. An interval of varying duration elapses from the ingestion of 
the poison until disturbance of the stomach ensues. This interval — 
one to three hours — is occupied by the solution and oxidation of the 
phosphorus. Then epigastric uneasiness, nausea, and vomiting, come 
on ; first, the contents of the stomach, and then mucus and bilious mat- 
ters being ejected. The vomiting, accompanied by considerable epi- 
gastric pain and tenderness, persists usually for several days, when it 
assumes a special character, owing to the presence of the so-called 
"coffee-grounds," or " black- vomit." At first the vomited matters 
have a distinct odor of phosphorus, and appear phosphorescent in the 
dark. After several days of vomiting these symptoms disappear, and 
there may then be more or less hsematemesis, as well as coffee-grounds, 
due to erosions of the mucous membrane (Wolfe). The condition of 
the intestines varies with the presence or absence of phosphorus in 
their contents. The stools may be simply pasty and grayish from the 
absence of bile, or they may contain mucus and blood, and appear 
phosphorescent in the dark. Accordingly, as they may or may not be 
irritated, will the symptoms be those of constipation, diarrhoea, or dys- 
entery. The very characteristic but not invariable symptom — jaundice 
— appears on the second to the fifth day after the reception of the 
poison. It is absent in one fourth of the cases, and may be absent, 
also, when there is considerable fatty degeneration of the liver (Wolfe, 
Alter). It presents the usual appearance of jaundice as it occurs in 
acute yellow atrophy. It does not attain the maximum at once, but 
it appears first as some yellowness of the conjunctiva, the urine also 
becoming dark and loaded with urates, at the same time. 

The chemical changes which phosphorus undergoes in the stomach, 
and the combinations by which it enters the blood, are as yet not fully 



114 RESTORATIVE AGENTS. 

explicable. That some phosphoric acid and phosphide of hydrogen 
are formed is certain. That the oil or fat in the stomach will dissolve 
some portion of the phosphorus, and thus facilitate its diffusion as 
phosphorus into the blood, is highly probable (Husemann and Marme). 
Phosphorus is also slightly soluble in water at about 100° Fahr., and 
in organic fluids, as the bile, to a greater extent (Hartmann). As in 
the oxidation of phosphorus, phosphorous and phosphoric acids, and 
phosphide of hydrogen, are products, it is certain that these exert a 
poisonous influence to a greater or less extent in the stomach (Lecor- 
che). A portion of the agent taken undoubtedly enters the blood as 
phosphorus, and the subsequent changes in tissue-metamorphosis are 
due to its presence in the blood, where it has been detected by Bam- 
berger and others. With the entrance of the poison into the blood 
the action of the heart increases, and the temperature rises, the fever 
having a remittent type (Mannkopff). Toward the end, however, the 
function of haematosis and of tissue-metamorphosis are so depressed 
that the body -heat declines below normal. In other cases there is no 
fever at all, or it appears near the end. Very great weakness of the 
heart's action has usually been observed, and the pulse has been much 
accelerated, although in some instances it became very slow, descend- 
ing as low as 40. The damage done to the blood is shown in the 
haemorrhages which take place from the various mucous surfaces — from 
the nose, stomach, intestines, kidneys, uterus (menorrhagia and me- 
trorrhagia) — and into the areolar tissue, in the form of petechiae and 
ecchymoses. A haemorrhagic diathesis develops, so that the bleeding 
from a simple wound, a leech-bite, etc., may become uncontrollable. 

The intellect may remain unimpaired, but usually there are restless- 
ness, with coma, sometimes noisy delirium, anaesthesia of the extremi- 
ties, paresis of the members, and, near the end, convulsions (Hermann). 

The poison entering the blood is eliminated chiefly by the kidneys. 
The changes occurring in the urine are of especial interest. No depart- 
ure from the normal occurs until the alterations in the composition of 
the blood, and the general steatosis, prepare the way. The urine is 
diminished in amount, contains albumen, blood, and sometimes fibrin- 
ous casts. When jaundice comes on, its appearance is first announced 
by the presence of bile-pigments and acids. Urea almost entirely dis- 
appears toward the fatal termination ; leucin and tyrosin are occa- 
sionally present, and a peptone-like substance ; but the peculiarity most 
distinctive is the large quantity of paralactic acid, especially in the 
fatal cases (Schultzen and Biess). 

The duration of the cases of phosphorus-poisoning is by no means 
uniform. Although the rule is that symptoms do not follow immedi- 
ately on the entrance of the poison into the stomach, there are cases 
in which pain, nausea, and vomiting do occur almost immediately, and 
,the most formidable symptoms come on promptly. One case is re- 



PHOSPHORUS. 115 

ported in which death occurred within nine hours, and numerous cases 
have terminated in death at the expiration of forty-eight to seventy- 
two hours. But usually the cases are less acute, and death does not 
occur before the end of the first, second, or third week. It is impor- 
tant to bear in mind that death may take place unexpectedly, before 
the most severe symptoms manifest themselves (Naunyn) ; and that 
the absence of decided gastric disturbance does not necessarily in- 
dicate a mild case. When recovery takes place, the improvement is 
slow, and the duration more or less protracted. In cases observed by 
Schultzen, the swelling of the liver could be distinguished at the ex- 
piration of four weeks, although the jaundice and the haemorrhages 
had disappeared. 

The changes induced by phosphorus are eminently characteristic. 
In the stomach are found erosions of variable extent, often absent ; 
fatty degeneration of the epithelium ; and a gastro-adenitis, first de- 
scribed by Virchow, and confirmed by subsequent observers, notably 
by Bernhardt, whence the membrane has a swollen, grayish, or yellow- 
ish color. The same state of the mucous membrane may exist in the 
intestine as well. The liver is much enlarged as a rule, but may be 
atrophied. In five of the sixteen cases studied by Wolfe the liver was 
atrophied, but this is probably a more advanced change, and is, there- 
fore, encountered in the most protracted cases. The color of the liver 
is usually a pale yellow, or it may present a deep yellow, the acini ap- 
pearing enlarged and distinct. The increased size of the organ, and 
the change in its appearance, are due to fatty degeneration of the he- 
patic cells and epithelium (Mannkopff) ; but, according to some other 
authorities, an interstitial hepatitis is also set up, which is especially 
well marked in chronic phosphorus-poisoning. The jaundice, it is 
agreed generally, is due to resorption of the bile, swelling of the bile- 
ducts and of the orifice of the ductus communis preventing the en- 
trance of the bile into the intestine. The presence of bile-pigments 
and acids in the urine supports this view, but it has also been main- 
tained that the jaundice is hematogenic from dissolution of the 
blood. 

The changes in the composition of the blood are numerous and im- 
portant : it is fluid, non-coagulable, its corpuscles altered in form, and 
it contains much fat (Mehu). There are numerous ecchymoses, es- 
pecially under the peri- and endo-cardium (noted in thirteen out of six- 
teen cases by Wolfe), under the capsule of the liver, and in other 
situations. Besides the alterations in the blood, the occurrence of 
ecchymoses is favored by fatty degeneration of the small blood-vessels 
and capillaries (Klebs). The heart is also the seat of an acute fatty 
degeneration, and its tissue is soft and easily torn. The spleen is en- 
larged, and the kidneys are also enlarged and fatty, the renal epithe- 
lium being crowded with oil-drops. 



116 RESTORATIVE AGENTS. 

Not every case exhibits the wide- spread changes above described. 
If death occur in a short time, within nine hours, as has been noted, 
not sufficient time will have elapsed to allow of universal steatosis. 
There may, indeed, be no characteristic morbid appearances under such 
circumstances. In other cases, the changes may be limited to the liver. 

Chronic poisoning by phosphorus presents some interesting features. 
It occurs in those who are exposed to the vapor, in workmen engaged 
in phosphorus-factories, and especially in the workers in match-facto- 
ries. Irritation of the bronchial mucous membrane, and to a less ex- 
tent of the gastro-intestinal, takes place, with the attendant symptoms 
of cough, loss of appetite, indigestion, constipation, failure of nutri- 
tion, etc. The most important change is that occurring in the maxilla, 
more especially in the inferior maxilla, which is both more severely and 
more frequently diseased. The lower jaw has been repeatedly re- 
moved for this phosphorus necrosis, which begins in carious teeth, 
develops into a periostitis, and ends in death of the bone. The alve- 
olar process only, or a part or the whole of the bone, may be cast off. 
Phosphorus increases the production of osseous tissue ; the spongy 
tissue is thickened, and the compact is rendered more dense. Exten- 
sive osteophytic formations take place in animals fed on it, and the 
marrow cavity of long bones may be much encroached on, even closed, 
by the deposit of new osseous material (Wegner). 

Therapy. — The author enjoins on his readers the necessity for 
caution in the use of phosphorus. As this agent so readily induces an 
acute fatty degeneration, when taken in poisonous quantity, the pro- 
priety of its administration in large doses for long periods may well 
be questioned. 

Phosphorus, occupying an important position as an agent utilized 
in the constructive metamorphosis, may properly be prescribed when 
the nutritive functions are deficient in activity. It is especially in 
nutritive failure of the osseous and nervous tissue that phosphorus is 
required. The original suggestion by Wegner of its probable utility 
in osteomalacia, or softening of bones, has been acted on by Friese, 
who found it remarkably beneficial in some obstinate cases. It will 
prove useful, also, when this condition exists in rickets. That hitherto 
incurable malady — progressive pernicious anamiia — has in some in- 
stances been apparently arrested by the administration of phosphorus ; 
but it has failed in others. Further investigations are needed. 

The physiological action of phosphorus in small doses in increasing 
mental activity finds a therapeutical expression in the use of its prep- 
arations in cerebral disorders. It is indicated in pathological states 
dependent on anaemia, and contraindicated in vascular congestion and 
excitement. Cases of wakefulness, dependent on cerebral anaemia and 
exhaustion, are often remarkably benefited by phosphorus in the form 
of the pill or tincture. It does not procure sleep in the way that 



PHOSPHORUS. 117 

chloral and bromide of potassium do. By the use of it in suitable 
states we supply to the cerebral substance a material which it requires 
for the healthy performance of its functions. It acts most beneficially 
in the cases of wakefulness in which the nutritive functions of the 
body are wanting in activity. The wakefulness of the aged, accom- 
panied with muscular cramps, feebleness of memory, giddiness, and 
trembling of the voluntary muscles on exertion, is improved by the 
preparations of phosphorus. Early decay of the mental powers, asso- 
ciated with atheromatous changes of the cerebral vessels, and conse- 
quent impaired nutrition of the brain, is benefited by minute doses of 
this agent. In these states, occurring in the aged, it is better to com- 
bine with the phosphorus, or to administer simultaneously, cod-liver 
oil. The author has seen good results from such a combination in 
paralysis agitans. Large doses of the medicine in these disorders of 
advanced life are improper and unsafe. The best results are obtained 
from the persistent use of minute doses. M. Delpech has obtained 
excellent results from the use of phosphorus in paralysis. It is ob- 
viously adapted to cases of chronic character in which all acute symp- 
toms have subsided. The paralytic symptoms which accompany white 
softening of the brain (local and circumscribed anaemia) have appeared 
to the author to be improved by the use of the phosphates, hypophos- 
phites, and lacto-phosphate of lime. 

The preparations of phosphorus are very serviceable in neuralgia. 
It is true Dr. Anstie, in his recent able work on neuralgia, expresses 
the opinion that " its utility is not very extensive or reliable." Rad- 
cliffe, Bradley, Broadbent, Mr. J. Ashburton Thompson, on the other 
hand, report cures in some obstinate cases. Mr. Thompson's experi- 
ence indicates that large doses are necessary to effect a cure. In his 
own words : " I now invariably begin by giving ^ of a grain every 
four hours, and this I conclude to be an average dose." The formula 
given under the title " Tinctura Phosphori " is Mr. Thompson's ; each 
drachm of it contains ^ of a grain of phosphorus. With this solution 
he has treated successfully thirteen cases of neuralgia. Dr. Broadbent 
has given phosphorus with advantage in " epileptiform vertigo," neu- 
ralgia, and "nervous breakdown from overwork." 

We have no remedy at present more efficient in the treatment of 
impotence than phosphorus. In the physiological state, priapism is 
one of the results of its toxic action. It is, of course, adapted only to 
cases functional in character, and not to impotence from organic de- 
fect. 

According to Dujardin-Beaumetz, phosphorus is useful in that very 
protracted and troublesome disease, progressive locomotor ataxia, or 
posterior spinal sclerosis. Although the author has not observed any 
instances of cure of this affection by phosphorus, he has witnessed in 
a few instances decided amelioration. 



118 RESTORATIVE AGENTS. 

Phosphorus has lately been employed as a substitute for arsenic in 
the skin-diseases for which the latter is used — notably acne, psoriasis, 
lupus. The author has seen excellent results from the use of the com- 
pound sirup of the hypophosphites in acne indurata. 

Authorities referred to in this article : 

Alter, "W". Experimentelle Beitrage uber die Ursachen des Icterus hex Phosphorver- 
giftungen. Diss. Breslau. V. u. H., vol. i, 1867. 

Andant, Dr. P. E. Bull. Gen. de Therap., tome lxxv, p. 269. Ibid., tome lxxvi, p. 
273. 

Anstie, Dr. F. E. Neuralgia and its Counterfeits, London, 1871. 

Bamberger, H. von. Wurzbl. med. Ztschr., Band 7, 1. Full abstract in Virchow u. 
HirscKs Jahresbericht for 1867, vol. i. 

Bennett, Dr. James Risdon. The Medical Times and Gazette, vol. i, 1861, p. 438. 

Bernhardt, M. Pie Veranderungen des Magens nach Phosphorvcrgiflung. Virchow's 
Archiv, Band 39, p. 23. 

Berthold, A. Arcliiv der Heilhunde, 1876, p. 258. 

Bradley, G. M. The British Medical Journal, October, 1872. 

Broadbent, Dr. W. H. The Practitioner, April, 1873, p. 230. 

Dusart, M. The Lancet, vol. ii, 1870, p. 122. 

Ebstein, Dr. Archiv der Heilhunde. Quoted in Schmidt's Jahrbucher, vol. cxiv, 
p. 283. . 

Eulenburg and Landois. Pie Transfusion bei acuten Phosphorvergift. Centralblatt 
f. d. med. Wiss. Virchow u. Hirsch's Jahresbericht, 1867, vol. i. 

Hartmann, Jul. Zur acuten Phosphorvergift. Diss. Dor pat. Ibid., vol. i, 1867. 

Husemann, Th. and W. Marme. Ibid., vol. i, 1866. 

Kohler, II. Berlin, klin. Wochen., i, 1870, p. 5. Ibid., Wiener Presse, various num- 
bers, 1873. 

Laboulbene, Dr. Gaz. des Hopitaux, xlvi, 1879, p. 361, and Gaz. Hebdom., 1874, 
xxxiii, p. 524. 

Lecorche, Dr. Archives de Physiologie Norm, et Path., tome ii, 1869. 

Lebert, H. and "VVtss, 0. Etudes cliniques et experimental sur V empoisonnement aigu 
par le phosphor. Archives General de Medicine, September, October, November, and 
December, 1868. 

Munk und Leyden. Die acute Phosphorvergiftung, Berlin, 1865. A. Hirschwald. 

Personne, M. Bulletin General de Therapeutique, tome lxxvi, p. 353. 

Radcliffe, Dr. C. B. The British Medical Journal, 1863, p. 489. 

Ranvier, Dr. L. Gaz. Med. de Paris, 27, 28, 1867. Recherches experimental au 
sujet de Paction du phosphor sur les tissus vivants, etc. 

Rommelaere, Dr. Du Traitement de V empoisonnement par le phosphore. Bull. Gen. 
de Therap., vol. lxxxii, p. 145. 

Senftleben, Dr. Virchow's Archiv, vol. xxxvi, p. 530. 

Schraube, Dr. Otto. Uebersicht neuer Mitthcilungen uber acute Phosphorvergiftung. 
Schmidt's Jahrbucher, Band 136, p. 207. 

Sorbets, Dr. Bull. Gen. de Therap., vol. Ixvii, p. 42. 

Thompson, J. Ashburton. The Practitioner, vol. ii, p. 13. 

Vetter, Dr. A. Ueber die acute Phosphorvergiftung und deren Behandlung. Virc7iou y s 
Archiv, Band 53, p. 168. 

Virchow, R. Der Zustand des Magens bei Phosphorvergiftung. Virchow' s Archiv, 
Band 31, p. 399. 

Wegner, Dr. Georg. Der Einfluss des Phosphors auf den Organismus. Ibid., Band 
55, p. 11. 



PHOSPHITES AND PHOSPHATES. 119 

Wolfe, Jean. Disser. Berolini. Full Abstract in Virchow u. Hirscfts Jahresbericht, 
vol. i, 1868. An Account of the Morbid Appearances in Sixteen Cases of Phosphorus- 
Poisoning, occurring in Berlin from 1861 to 1868. 

PHOSPHITES AND PHOSPHATES. 

Preparations. — Syrupus Calcii Lacto-phosphatis. — Sirup of the 
lacto-phosphate of lime. Dose, a teaspoonful. Lactic acid has the 
property of dissolving freshly-precipitated phosphate of lime. 

Compound Sirup of the Phosphates (not official). — Parrish's chemi- 
cal food. Each drachm contains two and a half grains of phosphate 
of iron and one grain of phosphate of lime. 

Syrupus Hypophosphitum. — Sirup of the hypophosphites. Com- 
posed of hypophosphites of calcium, sodium, and potassium. Dose, a 
teaspoonful three times a day. 

Syrupus Hypophosphitum cum Ferro. — Sirup of the hypophos- 
phites with lactate of iron. Dose, a teaspoonful three times a day. 

Sodii JPhosphas. — Phosphate of sodium. " Large, colorless, trans- 
parent, monoclinic prisms, speedily efflorescing on exposure to air, 
odorless, having a cooling, saline, and feebly alkaline taste, and a 
slightly alkaline reaction. Soluble in six parts of water at 60° Fahr., 
and in two parts of boiling water." Dose, one drachm to one ounce. 

Sodii JPyrophpsphas. — Pyrophosphate of sodium. " Colorless, 
translucent, monoclinic prisms, permanent in the air, odorless, having 
a cooling, saline taste, and a slightly alkaline reaction. Soluble in 12 
parts of water at 60° Fahr., and in 1*1 boiling water ; insoluble in 
alcohol." Dose, half a drachm to half an ounce. 

Calcii Hypophosphis. — Hypophosphite of calcium. " Colorless or 
white six-sided prisms, or thin, flexible scales, of a pearly luster, 
permanent in dry air, odorless, having a nauseous, bitter taste and a 
neutral reaction. Soluble in 6*8 parts of water at 60° Fahr., and in 
six parts of boiling water." Dose, gr. ij — gr. x. 

Calcii Phosphas Prwcipitatus. — Precipitated phosphate of lime. 
"A light, white, amorphous powder, permanent in the air, odorless, 
tasteless, and insoluble in water or alcohol." Dose, gr. ij — gr. v. 

Sodii Hypophosphis. — Hypophosphite of sodium. Small, colorless 
or white, rectangular prisms, or a white granular powder, having a 
sweetish, saline taste and a neutral reaction. Soluble in one part of 
water. Dose, gr. v — gr. x. 

Physiological Actions. — In the first edition of this work the 
phosphates were included in the same section with phosphorus. There 
is a strong argument in favor of this arrangement, based on the chem- 
ical reactions which ensue when phosphorus is introduced into the 
stomach. Phosphorus has a strong affinity for oxygen, and compounds 
are quickly formed in the stomach. It is probable, however, that some 
phosphorus enters the blood uncombined. It is certain that the effects 



120 RESTORATIVE AGENTS. 

of phosphorus differ in character from the effects of any of its com- 
pounds. They agree in the property of aiding constructive metamor- 
phosis, but differ widely in other respects. 

Physiological Actions of Phosphate of Lime. — There is no 
part of the body which does not contain, or does not yield on incinera- 
tion, phosphate of lime. It gives solidity to the osseous framework of 
the body, and, when too little is furnished during the growing period, 
rickets and mollities ossium are the result. The demand made on the 
system of the mother for the supply of this essential material for the 
growth of the osseous structure of the foetus is so great that her frac- 
tured bones unite with difficulty. The bones of animals, fed on food 
deficient in phosphate of lime, soften. All the animal fluids contain 
this substance in solution : thus it is found in the blood, the saliva, the 
gastric juice, milk, urine, and in the intercellular fluid throughout the 
body. It accumulates wherever tissue-changes are rapidly taking place 
(Dusart). It is obviously very important to the nutritive j^rocesses of 
the body. 

As phosphate of lime is to a limited extent soluble in lactic and 
hydrochloric acids, it is evident that, administered by the stomach, 
diffusion into the blood must occur. Large amounts can not, however, 
be disposed of in this way ; hence small doses must be as effective, in 
the treatment of the maladies for which it is prescribed, as large ones 
— for all in excess of the quantity soluble in the free acids of the 
stomach must pass off with the faeces or form intestinal concretions. 

Physiological Actions of Phosphate of Sodium. — This salt is 
soluble in water in the proportion of four per cent. Hence it may be 
given in solution, and will readily diffuse through into the blood. In 
the dose of one ounce it acts as a laxative. As it has a saline taste 
similar to common salt, it may be given in soup or other food. It in- 
creases the alkalinity of the blood, according to Bocker, by causing a 
retention of the chloride of sodium. Phosphate of soda diminishes the 
excretion of urea, in part, it is supposed, by hindering the retrograde 
metamorphosis of tissue, in part by its interference with the process of 
digestion. It is a constituent of the blood in the normal state, and as 
it possesses the remarkable property of increasing the quantity of car- 
bonic acid which can be held in solution by any liquid, obviously we 
have in these facts an explanation of its influence over the excretion 
of urea. That it impairs digestion in large doses when administered 
in health may be admitted, but by removing morbid states of the mu- 
cous membrane the digestive function, in suitable cases, is directly 
promoted by its use, and the nutrition of the body generally, and the 
tone of the nervous system, improved. 

Therapy. — In cases of the so-called bilious sick-headache, phosphate 
of soda is a most useful laxative. A permanent cure of this very 
troublesome malady may be wrought by regulation of the diet, and by 



PHOSPHITES AND PHOSPHATES. 121 

the long-continued use of this remedy. It is not pretended that cases 
of migraine, due to an affection of the nucleus of the fifth, may be thus 
cured. A large proportion of these cases are produced by a catarrhal 
state of the gastro-intestinal mucous membrane, which the phosphate 
of soda has the power to remove. For the same reason, it is a remedy 
of the highest utility in cases of jaundice dependent on catarrh of the 
bile-ducts, this disease being secondary to the same process in the in- 
testinal mucous membrane. In these affections the phosphate of soda 
should be administered in a drachm dose (about one teaspoonf ul) three 
times a day, or more frequently. Children, who are frequently sub- 
jects of this disorder, do not require larger doses than ten grains to a 
scruple. In preventing inspissation of the bile and crystallization of 
cholesterin, and attacks of hepatic colic, the persistent use of the phos- 
phate of soda is rarely unsuccessful. It is not pretended that this 
agent can relieve the attacks of hepatic colic, and, indeed, it is useless 
at these times. Many cases of this disease, if not most of them, origi- 
nate in a catarrh of the duodenum, the transference of the catarrhal 
state by continuity of tissue to the gall-bladder, and the formation of 
a nucleus of mucus and bile, about which the cholesterin crystallizes. 
Phosphate of soda has the property to prevent the occurrence of these 
changes, and consequently to prevent attacks of hepatic colic. The 
author has found one scruple to drachm doses, administered for several 
months before each meal, extremely efficacious in a number of cases 
of this kind. The value of Yichy in this and kindred affections 
probably depends on the phosphate of soda contained in this mineral 
water. 

Many ill-conditioned children are found to pass pasty and white 
stools, showing the absence of bile, and are pale and ill-nourished not- 
withstanding an abundant supply of milk and a vigorous appetite. 
Ten grains of phosphate of soda, dissolved in the milk and given 
them several times each day, will often improve the intestinal di- 
gestion, change the appearance of the stools, and increase the nu- 
trition of the body. 

The phosphates are especially useful in diseases characterized by 
mal-nutrition. In rickets, mollities ossium, delayed union of fractures, 
early decay of the teeth in children, caries and necrosis of bone, in 
which the phosphate is needed to the repair and growth of the osseous 
structures, it may be supplied artificially. The phosphate of lime 
may be administered alone in these states, but is to be preferred in 
the form of the sirup of the lacto-phosphate, or of Parrish's phosphates. 
As a large consumption of the phosphate of lime takes place during 
suckling, the anaimia of the nursing mother may be most advan- 
tageously treated with the lacto-phosphate of lime or phosphates. 
The waste caused by suppuration, carbuncles, mammary abscesses or 
boils, may be best repaired by the same means. The constitutional 



122 RESTORATIVE AGENTS. 

cachexia produced by chronic bronchitis with profuse expectoration, 
leucorrhcea, and similar exhausting discharges, may be much improved 
by the phosphates, and with the general improvement of the bodily 
state there usually takes place an arrest of the local morbid process. 

The explanation of the therapeutical action of the phosphates in the 
diseases just mentioned is equally true of their use in phthisis. The 
utility of the hypophosphites in this disease is not any greater, for it is 
probably true that these preparations undergo oxidation in the stomach 
and pass to phosphates. The compound sirup of the hypophosphites 
is an agreeable preparation and is readily taken, and certainly proves 
serviceable in the more chronic forms of the disease. The lacto-phos- 
phate, the phosphates, and the hypophosphites, are undoubtedly useful 
in chronic phthisis, fibroid lung, chronic tuberculosis, emphysema, and 
dilated bronchi, but no advantage can be expected from them in acute 
tuberculosis and caseous pneumonia. The utility of these preparations 
in these groups of maladies depends on their power to promote con- 
structive metamorphosis. If they improve the appetite, promote diges- 
tion, and increase the body- weight, they do good ; if they disagree with 
the stomach, they do harm (Bennett). Not unfrequently the sirup of 
the hypophosphites gives rise to distressing tormina. This may be 
obviated by combining with it dilute phosphoric acid — a combination 
very effective, therapeutically : $ Syrp. hypophos. comp., 1 iijss ; acid, 
phosphor, dil., § ss. M. S. : A teaspoonf ul three times a day. Such a 
combination may be advantageously given with cod-liver oil, after meals, 
in chronic phthisis. The addition of arsenic contributes very materially 
to the therapeutical effects of the lacto-phosphate ; for example : I£ 
Syrp. calcii lacto-phos., 3 iv ; liq. potassii arsen., 3 j. M. S. : A dessert- 
spoonful ter die. 

Late favorable reports regarding the curative effects of phosphorus 
and its compounds in pernicious anaemia have not been confirmed by 
the most recent experience. 

Percy, who has distinguished himself by researches on phosphorus, 
prepares hypophosphorous acid by passing through a solution of phos- 
phorus in oil, perfectly pure and dry oxygen. He maintains that hy- 
pophosphorous acid is the only preparation of phosphorus which should 
be employed in medicine. 

Further experience with the phosphate of soda justifies the author 
in the expression of his belief that it has the power to retard the 
growth of the changes known as sclerosis of the liver, and possibly, 
under favorable circumstances, to arrest them and to restore a com- 
paratively normal functional state. When, in obese subjects, a succes- 
sion of boils portends the development of diabetes, this remedy is 
highly useful. It has seemed very beneficial in the hepatic form of 
diabetes. No remedy is more effective in removing that condition of 
the system which produces furuncles, or boils. 



IRON. 123 

IRON AND ITS PREPARATIONS. 

Ferrum. — Fer, Fr. ; Eisen, Ger. " In the form of fine, bright, non- 
elastic wire." 

Ferrum Peductum. — Reduced iron. Ferri pulvis. A tasteless 
powder of an iron-gray color. Dose, gr. ss — gr. ij. 

Ferri Carbonas Saccharatus. — Saccharated carbonate of iron. A 
greenish-gray powder, odorless, having at first a sweetish, afterward 
a slightly ferruginous taste. It is only partially soluble in water. 
Dose, gr. ij. 

Trochisci Ferri. — Troches of hydrated oxide of iron. Composition : 
Hydrated oxide of iron, vanilla, sugar, and mucilage of tragacanth. 
Dose, one to five. 

Ferri Oxidum Hydratum. — Hydrated oxide of iron. Kept in the 
form of a soft magma and used as an antidote to arsenic. 

Ferri Oxidum Hydratum cum Magnesia.— Hydrated oxide of 
iron with magnesia. (For arsenical poisoning.) 

Pilulce Ferri Compositce. — Compound pills of iron. Composition : 
Myrrh, carbonate of sodium, sulphate of iron. Dose, one or two pills. 

Massa Ferri Carbonatis. — Mass of carbonate of iron (Vallet's 
mass). Sulphate of iron, carbonate of sodium, honey, sugar, etc. Dose, 
gr. iij— gr. v. 

Mistura Ferri Composita. — Compound mixture of iron. Compo- 
sition : Myrrh, sugar, carbonate of potassium, sulphate of iron, spirit 
of lavender, rose-water. Dose, a tablespoonful. 

Emplastrum Ferri. — Iron-plaster, strengthening-plaster. Compo- 
sition : Subcarbonate of iron, lead-plaster, and Burgundy pitch. 

Ferri Hypophosphis. — Hypophosphite of iron. A white or gray- 
ish-white powder, odorless and nearly tasteless, only slightly soluble 
in water. 

Ferri Phosphas. — Phosphate of iron. A bright, slate-colored pow- 
der, insoluble in water. Dose, gr. ij — gr. v. 

Ferri Pyrophosphas. — Pyrophosphate of iron. In apple-green 
scales, having an acidulous, slightly saline taste, and wholly soluble 
in water. Dose, gr. ij — gr. v. 

Ferri Sulphas. — Sulphate of iron. In transparent, bluish-green 
crystals, which, on exposure to the air, effloresce and change color. Is 
wholly soluble in water. Dose, gr. j — iij. 

Ferri Sulphas Exsiccata. — Dried sulphate of iron. A grayish- 
white powder, soluble in water with the exception of a small residue. 
Dose, gr. j— gr. ij. 

Ferri Sulphas Praicipitatus. — Precipitated sulphate of iron. A 
pale, bluish-green powder ; oxidizes in contact with moisture ; solu- 
ble in 1*8 part of water at 60° Fahr. Dose, gr. ij — gr. v. 

Liquor Ferri Subsidphatis.— Solution of subsulphate of iron. Mon- 



124 RESTORATIVE AGENTS. 

sel's solution. Composition : Sulphate of iron, sulphuric acid, nitric 
acid. An inodorous, sirupy liquid, of a ruby-red color, and of an ex- 
tremely astringent taste, without causticity. It mixes with water and 
alcohol, in all proportions, without decomposition. 

Liquor Ferri Tersulphatis. — Solution of tersulphate of iron. Com- 
position : same as preceding preparation, except the quantity of acid. 
A dark, reddish-brown liquid, nearly devoid of odor, and of an acid 
and extremely styptic taste. 

Ferri Chloridum. — Chloride of iron. In orange-yellow, crystal- 
line pieces, very deliquescent, and wholly soluble in water, alcohol, 
and ether. Dose, gr. j — gr. ij. 

Liquor Ferri Chloridi. — Solution of chloride of iron. 

Tinctura Ferri Chloridi. — Tincture of chloride of iron. Compo- 
sition : Solution of chloride of iron, alcohol. Dose, TTi v — tti xx - 

Liquor Ferri JVitratis. — Solution of nitrate of iron. A transparent 
liquid, having a pale amber color. Dose, fq, ij — ttl v. 

Syrupus Ferri Lodidi. — Sirup of iodide of iron. A transparent 
liquid of a pale-green color. Composition : Iodine, iron, sirup. Dose, 
tti x — TTt lx. 

Filulce Ferri Lodidi. — Pills of iodide of iron. Composition : Iodine, 
iron, sugar, liquorice, and gum-arabic. Dose, one to three pills. 

Liquor Ferri Citratis. — Solution of citrate of iron. 

Ferri Citras. — Citrate of iron. Dose, gr. ij — gr. v. " Transparent, 
garnet-red scales, odorless, and having a very faint ferruginous taste 
and an acid reaction ; slowly but completely soluble in cold water ; 
insoluble in alcohol." 

Ferri et Ammonii Citras. — Citrate of iron and ammonium. In 
garnet-red, translucent scales, having a slightly ferruginous taste, and 
readily and wholly soluble in water. Dose, gr. ij — gr. v. 

Ferri et Ammonii Sulphas. — Sulphate of iron and ammonium. 
Ammonio -ferric alum. In octahedral crystals of a pale violet color, 
soluble in one and a half part of water at 60°. Dose, gr. j — gr. ij. 

Ferri et Ammonii Tartras. — Tartrate of iron and ammonium. In 
transparent garnet-red scales, which have a saccharine taste. It is 
slowly soluble in rather more than its weight of water, but insoluble 
in alcohol and ether. Dose, gr. ij — gr. v. 

Ferri et Potassii Tartras. — Tartrate of iron and potassium. In 
transparent scales, of a dark ruby-red color, and wholly soluble in 
water. Dose, gr. ij — gr. v. 

Ferri et Quininm Citras. — Citrate of iron and quinia. In thin, trans- 
parent scales, reddish or yellowish brown. Taste ferruginous and bit- 
ter. Slowly soluble in cold, more readily in hot water, and not soluble 
in alcohol and ether. Dose, gr. j — gr. v. 

Liquor Ferri et Quininm Citratis. — Solution of the citrate of iron 
and quinine. Contains 6 per cent of quinine. 



IRON. 125 

Ferri et Strychnince Citras. — Citrate of iron and strychnine. Con- 
tains one grain of strychnine to 100 grains of the compound. Dose, 

g r - j— g r - "J- 

Liquor Ferri Acetatis. — Solution of acetate of iron. 

Tinctura Ferri Acetatis. — Tincture of acetate of iron. A clear, 
dark, reddish-brown liquid, having the odor of acetic ether, an acidu- 
lous and astringent taste, and mixes with water in all proportions. 
Dose, tti x to 3 ij. 

Ferri Lactas. — Lactate of iron. In greenish - white crystalline 
crusts or grains, of a mild, sweetish, ferruginous taste, soluble in 
forty-eight parts of cold water, but insoluble in alcohol. Dose, gr. 
-gr. x. 

Ferri Oxalas. — Oxalate of iron ; a lemon-yellow, crystalline pow- 
der, insoluble in water. Dose, gr. ij — gr. v. 

Yinum Ferri Amarum. — Bitter wine of iron (solution of citrate 
of iron and quinine, tincture of sweet orange-peel, sirup, and stronger 
white wine). Dose, a teaspoon ful to a tablespoonful. 

Yinum Ferri Citratis. — Wine of citrate of iron. Dose, a tea- 
spoonful to a tablespoonful. 

Besides the official preparations of iron, there are numerous unoffi- 
cial formulae to which some attention must be paid. The following 
are the most meritorious of these : 

Ferri Arsenias. — Arseniate of iron. A tasteless powder of a green 
color, insoluble in water, but soluble in hydrochloric acid. Dose, gr. 

tV— gr- h 

Syrupus Ferri et Manganesii Iodidi. — Sirup of the iodides of iron 
and manganese. Dose, 3 j. 

Mistura Ferri Aromatica. — Composition : Pale bark in powder, 
4 ; calumba, in powder, 2 ; cloves, bruised, 1 ; iron wire, 2 ; compound 
tincture of cardamoms, 12 ; tincture of orange-peel, 2 ; peppermint- 
water, 50 ; macerate the first four ingredients in the last one for three 
days, agitating occasionally, filter, add the tinctures, and make up to 
50. Dose, § j — ij (Squire). 

Syrupus Ferri et Manganesii Phosphatis. — Sirup of the phosphate 
of iron and manganese. Dose, 3 j. 

Mistura Ferri Laxans. — Composition : Sulphate of iron, 2 grains ; 
sulphate of magnesia, 1 drachm ; dilute sulphuric acid, 3 minims ; 
spirit of chloroform, 20 minims ; peppermint-water to 1 oz. (Squire). 

Ferrum Dialysatum. — Dialyzed iron. This preparation is made by 
the process of diffusion, and is iron in the colloid state. It is odorless, 
without the styptic taste of the ferruginous preparations, does not 
blacken the tongue and teeth, is free from irritant action, and does 
not constipate. It is precipitated by sulphuric acid, by acids, and by 
various salts, but neither by alcohol nor sugar. It is doubtful whether 
it be a good form in which to administer iron. Dose, tti, v — 3 i. If 



126 RESTORATIVE AGENTS. 

any given preparation has a styptic taste, and acts on the tongue and 
teeth, it is not genuine. 

Reduced iron is one of the most useful ferruginous preparations for 
internal administration, comparatively tasteless, and therefore easy of 
administration, and readily soluble in the juices of the stomach. The 
objection to its use is the occurrence of eructations, sulphureted or 
phosphureted, owing to the oxidation of the iron, the evolution of 
hydrogen, and the combination of the nascent hydrogen with sulphur 
or phosphorus. 

The so-called subcarbonate of iron is really little more than the red 
oxide. In the official pilulae ferri carbonatis, the oxidation of the iron 
and the loss of carbonic acid are prevented by the sugar. This prepa- 
ration is very soluble in the stomach-juice, and is readily assimilated. 
The troches of carbonate of iron are convenient for administration to 
children, who take them readily. The hydrated oxide of iron is solely 
used as the antidote to arsenic in solution. For remarks on its admin- 
istration I have to refer the reader to the article on Arsenic. Corre- 
sponding to these carbonates are the pilulse ferri compositse, which 
contain iron in the form of the carbonate, sulphate of soda, and myrrh. 
The mistura ferri composita is also a solution of the carbonate, con- 
tains myrrh and sulphate of potash, with a sufficient quantity of the 
latter to form an emulsion w^hich suspends the iron. 

Of the phosphates the better preparation is the pyrophosphate, 
which is readily soluble, unirritating, and easily assimilable. The sul- 
phate is an active astringent, and is an efficient remedy. When pre- 
scribed in pillular form the dried sulphate should be used, as the sul- 
phate in efflorescing destroys the cohesion of the mass. Of the several 
solutions intended for topical use, the liquor ferri subsulphatis, or 
Monsel's solution, is the best, as it is powerfully styptic without being 
corrosive. The tincture of the chloride of iron is most agreeably taken 
in the form of Creuse's tasteless preparation, which appears to be an 
efficient chalybeate without possessing the causticity of the pharma- 
ceutical preparation. In the sirup of the iodide of iron and the sirup 
of the iodides of iron and manganese, sugar is used to prevent oxida- 
tion of the iron and the setting free of the iodine. In the iodide-of- 
iron pill the same result is obtained by sugar or gelatin coating. 

Less irritating to the stomach, but probably less efficient as chalyb- 
eates, are the combinations of iron with vegetable acids. These may 
be administered dissolved in Rhine, Catawba, or sherry wine. An 
elegant mode of prescribing them is in effervescence — the citrates or 
tartrates dissolved in a solution of citric or tartaric acid, and poured 
into a solution of sodium or potassium bicarbonate — to be drunk in 
effervescence. 

Antagonists and Incompatibles. — The carbonates are incompati- 
ble with acids and acidulous salts and vegetable astringents ; the 



IRON. 127 

citrates and tartrates with mineral acids, alkalies and their carbonates, 
tannic acid ; the iodides with acids, acidulous salts, alkalies and their 
carbonates, lime-water, vegetable astringents ; the tincture of the 
chloride, with alkalies and their carbonates, lime-water, carbonate of 
lime, magnesia and its carbonate, and astringent vegetables turn it 
black. 

Synergists. — All agents promoting constructive metamorphosis are 
synergistic to iron, especially animal aliment, the simple, aromatic, and 
astringent bitters, cinchona, manganese, bismuth, etc. 

Physiological Actions. — Although metallic iron is inert, yet in 
the stomach it enters into combination dissolved in the acids, and 
then acquires molecular activity. As a result of its oxidation in the 
stomach, hydrogen is liberated, which in its nascent state combines 
with sulphur, forming sulphureted hydrogen. In part, iron is ab- 
sorbed by the stomach, probably as an albuminate ; in part, in the 
intestinal canal. The stools under a course of iron become brownish 
and even black, a result which indicates that a part of the metal taken 
fails to be absorbed ; but, since it has been shown that, whether taken 
by the stomach or injected into the blood, elimination takes place by 
the intestinal canal, it remains uncertain how much is excreted or is 
merely discharged unaltered in the faeces. 

Iron is not a substance foreign to the organism. Chemical analysis 
has demonstrated its constant presence in the blood, in the gastric juice, 
chyle, lymph, bile, in the pigment of the eye, and in traces in the milk 
and urine. According to Gorup-Basanez (analysis of C. Schmidt), the 
blood of man contains one part of iron to 230 of red globules, and that 
of beef one part of iron to 194 of red globules. Iron exists in com- 
bination in haematin ; according to some in the state of oxide, accord- 
ing to others as metallic iron. That it performs a very important office 
is shown in the rapid construction of red blood-globules when iron is 
administered in anaemia. Without it haematin is not formed, and the 
red globules diminish in number. By its medicinal use we furnish to 
the blood a material which it needs. In health a mixed diet contains 
sufficient iron for all the purposes of the economy. The blood being 
improved in quality by the administration of iron, the tissues- are better 
nourished, and all the functions are performed with more vigor. 

The physiological action of iron is not limited merely to the con- 
struction of red blood. When there is no intolerance to its presence 
in the stomach, it promotes the appetite and invigorates the digestion. 
By increasing the disposition for food and the ability to dispose of it, 
iron acts as a stomachic tonic. Hence, when given in the healthy 
state, or when administered for too long a period in disease, the gas- 
tric glands become exhausted by over-stimulation, and then it is said 
the iron disagrees. Being a restorative, its use is contrainclicated in a 
condition of plethora, especially when there exists a tendency to haem- 



128 RESTORATIVE AGENTS. 

orrhage, or when there is reason to suspect an atheromatous state of 
the cerebral vessels. 

In large doses the soluble preparations of iron give rise to nausea 
and vomiting. Some of them possess more or less toxic activity ; the 
per-salts are more active than the proto-salts. The iodide and chloride, 
the nitrate and sulphate, are the most active, death having ensued 
from the tincture of the chloride in one case (Christison), and alarm- 
ing symptoms having occurred in others (Taylor). 

Certain of the salts of iron, the sulphates, the nitrates, the chlo- 
rides, possess a high degree of astringency. Hence they produce con- 
stipation when taken internally. Brought into contact with blood, 
they coagulate it, forming a tough, brownish magma ; and, as the al- 
buminous elements of the tissues are also solidified, they are powerful 
haemostatics. 

Iron is eliminated by several channels. Its passage down the in- 
testinal canal and exit by this route have already been alluded to. As 
the experiments of Lussana have shown, a large part of the iron which 
enters the portal circulation is eliminated by the liver in the bile. On 
the other hand, the chief part of the iron which is made to enter the 
systemic circulation is eliminated by the kidneys. Much of that which 
is absorbed from the intestinal canal enters the capillary system of the 
liver, diffuses through into the bile, and but a small part finally enters 
the systemic circulation. 

The acid and astringent preparations of iron act on the teeth with 
considerable energy, as the experiments of Dr. Smith (of Edinburgh) 
prove. 

The tincture of the chloride and the sulphate are more corrosive 
than the wine, and of course are more injurious than the compounds 
of iron with the vegetable acids. 

Therapy. — Iron-spray — a weak solution of the liquor ferri subsul- 
phatis ( 3 j — § viij) — is very serviceable as an astringent in obstinate 
cases of epistaxis. The nozzle of the delivery-tube of the spray-douche 
should be inserted just within the anterior nares, and the spray be 
driven with considerable force. The same application is beneficial in 
chronic coryza, but the objection to its use is the danger of coloring 
the teeth. In pulmonary haemorrhage, the same application made to 
enter the throat with the inspired air will often arrest the flow of blood ; 
and this, notwithstanding so little iron can pass the chink of the glottis. 

The subsulphate and pernitrate solutions are the most efficient 
remedies for arresting hcematemesis. They should be given in small 
doses — one or two drops, well diluted with ice-water, and frequently. 
In the absence of these, the tincture of the chloride may be used in the 
same way. In intestinal hemorrhage the astringent preparations of 
iron are much less beneficial, if, indeed, they serve any useful purpose 
— for they are converted into inert sulphides as they descend the canal. 



IRON. 129 

The author has seen the intestinal haemorrhage of typhoid fever much 
increased by the rectal injection of a solution of Monsel's salt. The 
bleeding from hemorrhoids may be much diminished and even arrested 
by washing the tumors, when they protrude, with the solution of the 
subsulphate. After the application of the iron, the tumors should be 
well oiled before returning them into the rectum. The solution of the 
pernitrate of iron has been very efficacious as an astringent in chronic 
diarrhcea and dysentery, in that known as the army diarrhoea. These 
diseases, as they occur in civil practice, may sometimes be arrested by 
this agent, but not usually, in the author's experience. A solution of 
the tincture of iron is one of the numerous remedies used to destroy 
the ascarides vermiculares — the thread- worms which infest the rectum. 
As the development of these parasites is favored by the anaemic state, 
it is good practice to conjoin with any local treatment the internal use 
of iron, notably the sirup of the iodide. 

Iron is frequently given with advantage to promote appetite and 
digestion merely. Indeed, it is the opinion of some eminent authori- 
ties that the chief use of iron as a remedy, even in anaemia, is to pro- 
mote the digestive function. For the purpose of increasing appetite 
and energizing digestion, the sulphate is the best chalybeate, unless, 
indeed, the mucous membrane prove intolerant. When digestion is 
feeble, and the intestinal movements sluggish, it is often advantageous 
to combine aloes with iron, as in the official aloes-and-iron pill, or with 
sulphate of magnesia, as in the mistura ferri laxans, the formula for 
which has been given. 

The condition most usually requiring iron is anosmia, a deficiency 
not only of the haematin but of the red corpuscles. Iron is given in 
this state with the view of supplying to the organism a material in 
which it is deficient, and in this way promoting the construction of the 
red globules. As, however, food, especially beef, is rich in iron, and 
as but a small amount of that administered is really assimilated, there 
is much reason for holding that at least an important function of iron 
in anaemia consists in its power to promote appetite and digestion. 
Practical physicians are familiar with the fact that iron improves but 
little, if at all, the condition of the anaemic, when it does not increase 
the desire for food and the ability to digest it. In anaemia, iron is 
given with two objects : to furnish a needed material to the blood ; to 
increase the energy of the primary assimilation. To accomplish the 
first object, small doses — one or two grains — of reduced iron or of the 
carbonates, or some one of the combinations with vegetable acids, are 
most suitable. The second object is best attained by the more active 
astringent preparations, especially the sulphate and the chloride. Large 
doses of these are frequently well borne. When they disagree, other 
salts may be tried, but preference should be given to the most astrin- 
gent preparation which the patient's stomach will tolerate. 



130 RESTORATIVE AGENTS. 

In chlorosis, the good effects of iron are not so conspicuous as in 
anaemia, although they are allied states. During a course of iron in 
chlorosis, purgatives are now and then necessary. Better results are 
obtained from a combination of iron and arsenic, and iron and strychnine, 
than from iron alone. The arseniate of iron is an excellent remedy in 
chlorosis, but it must be given in larger doses than the posological 
tables authorize, for it is by no means so actively toxic as is commonly 
supposed. A good formula is the following : 3 Ferri arseniat., gr. 
ij ; ext. cinchonae, gr. xij. M. Ft. pil. no. xij. Sig. : One three times 
a day after meals. 

In anaemia and chlorosis, the iron should be taken after meals to be 
mixed with the food. The preparations of iron should not be continued 
too long ; occasional intermissions in their use are necessary, otherwise 
the digestive organs become deranged, and the good effects are lost. 
Occasional purgation is useful, and acts in a way to favor the absorp- 
tion and assimilation of the iron. Air and exercise should always, if 
practicable, be prescribed in a ferruginous course, for the assimilation 
of iron is directly favored by these hygienic influences. 

The anaemia of chronic malarial poisoning is especially improved 
by iron. If enlargement of the spleen and engorgement of the portal 
circulation co-exist, the use of the compound jalap-powder should pre- 
cede the iron ; or the latter may be combined advantageously with 
resin of podophyllin, as follows : ^ Quininae, 3 j ; resinae podophylli, 
gr. iv ; ferri sulphatis exsic, 3j. M. Ft. pil. no. xx. Sig. : One three 
times a day. 

According to some, massa ferri carbonatis is preferable to the 
sulphate ; it is certainly sometimes better borne. I> Mas. ferri carbo- 
natis, 3 j ; acidi arseniosi, gr. j ; quininae sulph., 3ij. M. Ft. pil. no. 
xl. Sig.: Two pills three times a day. In enlarged spleen of malarial 
origin, a combination of sulphate of iron with sulphate of quinine is 
generally preferred. R Quininae sulphat., 3 j ; ferri sulphat. exsic, 3 jss. 
M. Ft. pil. no. xxx. Sig. : One pill three times a day, or four or five 
during the day. 

Although the preparations of iron are of little service in leucocy- 
thaimia, they are certainly in a high degree useful in pseudo-leucocy- 
thmmia, or cachexia of the spleen. In the latter disease the relative 
number of blood-corpuscles may be greatly reduced, but they can be 
increased in number and raised to the normal by the use of those 
materials needed by the blood-making organs, especially by the use of 
iron. 

In syphilitic cachexia, the preparations of the iodide of iron possess 
a high degree of utility. In sloughing phagedena, or simple chancroid, 
the iodide is frequently prescribed when these accidents occur in debili- 
tated constitutions. Some authorities prefer the tartrate of iron under 
these circumstances, but the iodide acts with more promptness and 



IRON. 131 

vigor. In the treatment of constitutional syphilis, the ferruginous prep- 
arations are only useful in so far as they may be applied to promote 
constructive metamorphosis. More commonly than is supposed by the 
advocates of special plans of treatment, tonic remedies, especially cha- 
lybeates, exercise a most favorable influence over the course and dura- 
tion of syphilis. $ Iodoformi, 3 j ; hydrargyri chloridi corrosiv., gr. 
j ; ferri redacti, 3j. M. Ft. pil. no. xx. Sig. : One pill three times 
a day. r> Iodoformi, chinoidin., ferri redacti, aa 3j. M. Ft. pil. no. 
xx. Sig. : One pill three times a day. 

Iron is one of the remedies most useful in the treatment of acute 
rheumatism. As was originally suggested by Reynolds, the tincture 
of the chloride is most serviceable. It is more especially adapted to 
the treatment of pale, delicate, and cachectic subjects, and is much 
less beneficial, if not positively harmful, in the plethoric and overfed. 
Given in suitable cases, the tincture of iron, in doses of Tq, xx — xxx 
every four hours, diminishes the pain, fever, and sweats, lessens the 
chances of cardiac mischief, and hastens convalescence. By retarding 
waste and favoring excretion of uric acid through the kidneys, the 
duration of the disease is shortened and a tedious convalescence is pre- 
vented. We owe to Dr. Anstie the important suggestion that tinc- 
ture of chloride of iron may be used successfully as a prophylactic 
against acute rheumatism. Here, again, the author must state, as a 
result of his personal observation, that such prophylactic treatment is 
very useful in weak and cachectic subjects and not applicable to the 
robust and full-blooded. The tincture of iron should be administered 
without delay in such weak subjects with a rheumatic history, when 
they complain of lassitude, muscular pains, sore joints, furred tongue, 
although they are yet free from fever and joint-swellings. 

The treatment of erysipelas by large doses (in, x — 3 j every four 
hours) of tincture of chloride of iron is now very generally adopted. 
It is questionable whether this practice is directly beneficial. Its utility 
depends chiefly on the support which it affords to the organism while 
laboring under a debilitating disease, and, as an abundant supply of 
aliment is prescribed with the iron, it is impossible to estimate in any 
given case how far the result may be attributable to the remedy. 

Influenced by the same considerations, the tincture of iron is fre- 
quently prescribed in diphtheria, alone or in combination with chlorate 
of potassa. Although it possesses no special utility in this disease, it 
may serve as one of the means for maintaining the forces of the body, 
and in this way indirectly contribute to a favorable result. There is 
no advantage in applying the tincture of iron to the fauces in diph- 
theria ; it is not a solvent of the false membrane, and can not prevent 
the spread of the exudation ; it is, however, now freely used, and it is 
said with good results. 

In the treatment of scrofula, strumous enlargement of the cervical, 



132 RESTORATIVE AGENTS. 

inguinal, and mesenteric glands, and in rickets, the preparations of iron 
occupy a most important place. In these affections the sirup of the 
iodide of iron is generally preferred, and excellent results are obtained 
from a combination of phosphate of iron and phosphate of lime, espe- 
cially in rickets. In these cases, also, the sirup of the iodides of iron 
and manganese is indicated. Iron is one of the remedies most fre- 
quently prescribed in chronic tuberculosis, but it has no special influ- 
ence over the deposition of tubercle. It helps to a better state of the 
blood-making process, and, by promoting the constructive metamor- 
phosis, hinders the progress of the malady. 

As neuralgia so often depends on anaemia, it happens that iron is 
one of the most frequently prescribed remedies for this disease. Anstie 
prefers large doses (th, xxx — xl ter die) of the tincture of the chloride, 
and twenty-grain doses of the saccharated carbonate twice or three 
times a day. 

In disorders of the mind, either dependent on or increased by an 
anaemic state, iron is often useful. In chronic mania and melancholia, 
when debility is present, iron is employed as a restorative agent. The 
ferruginous preparations are especially useful in the anaemic forms of 
puerperal mania, and in the insanity of lactation. Bucknill and Tuke 
prefer the tincture of the chloride in these affections. 

Whenever epilepsy occurs in weak and anaemic subjects, iron is indi- 
cated. Cases of this disease, essential in character and dependent on 
cerebral anaemia, are sometimes cured by iron alone. The author has 
seen excellent results from a combination of bromide of iron and 
bromide of potassium in such cases : fy Potassii. bromidi, § j ; ferri 
bromidi, gr. iv ; aquae, f ij ; syrup, simplicis, § vj. M. Sig. : A table- 
spoonful bis die. 

Large doses of subcarbonate of iron have long been used with ad- 
vantage in chorea. When the subject of this disease is distinctly 
anaemic, iron, in some of its forms, is unquestionably serviceable, and 
its utility is often increased by combination with purgatives. When 
anaemia is not present, arsenic is preferable to iron. Chorea arising 
from moral causes (anger, fright, etc.), and from pregnancy, is not 
benefited by iron. This remedy is especially adapted to the chorea of 
anaemic girls about the age of puberty. 

The preparations of iron are of course inadmissible in acute affec- 
tions of the respiratory organs, but, in certain of the chronic forms 
and stages of these diseases, some of the chalybeates are very useful. 
In chronic bronchitis, with free expectoration, the mistura ferri com- 
posita has long been used with advantage. At the present time the 
phosphate of iron, quinine, and strychnine, is generally preferred in 
chronic bronchitis, in the chronic forms of phthisis, in emphysema, 
and in humid asthma. Iron is contraindicated when pulmonary haem- 
orrhage exists or is threatened. A combination of tincture of digitalis 



IRON. 133 

and tincture of chloride of iron abates the temperature and diminishes 
the sweats of hectic fever. 3 Tinct. digitalis, 3 iij ; tinct. f erri chlo- 
ridi, 3 v. M. Sig. : Fifteen drops three or four times a day. 

In fatty degeneration of the heart, the preparations of iron render 
important service, by improving the nutrition of the organ. The pal- 
pitations, the murmur, and precordial anxiety which accompany cases 
of anaemia and chlorosis, are relieved by chalybeate medicines. In 
dilatation of the cavities of the heart, especially the right, accompanied 
by cough, difficult breathing, and general dropsy, greater relief is some- 
times experienced from the preparations of iron than by the so-called 
cardiac sedatives and diuretics. In these cases, as also in mitral regurgi- 
tation, the distress of the patient increases with increasing thinness of 
the blood, and is diminished by those remedies, such as iron, which 
improve the quality of the blood. A combination of iron, digitalis, and 
squill, is sometimes extremely serviceable in these cases — for example : 
1} Ferri redacti, quininae sulphat., pulv. digitalis (English), aa 3 j ; pulv. 
scillae, gr. x. M. Ft. pil. no. xx. Sig. : One pill three or four times a 
day. Iron may be used with advantage to assist in the process of 
compensation in valvular lesions, when the condition is one of anaemia. 
Iron is contraindicated in all cases of cardiac disease occurring in those 
who are full-blooded. 

In the passive forms of hemorrhage — in purpura, the hemorrhagic 
diathesis, epistaxis, gastric, intestinal, and renal hemorrhage, when 
they are due to anaemia or favored by it — iron is unquestionably use- 
ful, and the preparation most generally applicable is the tincture of 
the chloride. 

Derangements of the menstrual function, when associated with 
anaemia, more especially when produced by anaemia, are often removed 
by the use of chalybeate medicines. Amenorrhea is, more frequently 
than to any other cause, due to anaemia of the ovaries, consecutive to 
chlorosis or general anaemia, and dysmenorrhea may depend, in one of 
its forms at least, upon the same condition of the blood. Menorrhagia 
may also be one of the results of an impoverished state of the blood. 
Iron is the most appropriate medicament in these disorders. It is the 
judgment of Graily Hewitt and Barnes that " small doses of iron are 
generally the best " in amenorrhea. Barnes prefers the solution of the 
acetate, and speaks favorably of the citrate of iron and ammonia, given 
in an effervescent state, and of the combination of iron and strychnine. 
The use of ferruginous preparations in menstrual disorders should be 
determined by the results of a careful differentiation of the causes. 
The absence of the uterus and ovaries, occlusion of the cervix, and 
various other conditions besides anaemia, should be eliminated, and the 
use of iron restricted to those cases in which an impoverished state of 
the blood is either the only factor or an influential one. 

The iDJection of the various styptic solutions of iron into the 



134 RESTORATIVE AGENTS. 

uterine cavity, to arrest post-partum haemorrhage, is now common 
practice. Notwithstanding the alleged innocuousness of this treat- 
ment, it is probable, as Snow Beck has shown, that fatal results have 
ensued from the incautious use of these injections. The official solu- 
tions of the perchloride and subsulphate have been thrown into the 
uterine cavity, with the effect to cause uterine thrombosis, followed 
by systemic infection. These solutions are much too strong ; one part 
of Monsel's solution to three of water is sufficiently styptic, and is 
probably perfectly safe. The uterine cavity should be cleared of clots, 
and the nozzle of the syringe carried well up to the fundus, when the 
injection should be slowly delivered. The reader need hardly be re- 
minded that this expedient is only proper after the usual means for 
securing uterine contractions have failed. The same plan of styptic 
injections has been used to arrest the haemorrhage from abortion, but 
caution is necessary in these cases, for it is essential to safety that 
there be an open and patulous condition of the os, to permit escape of 
coagula. Similarly these injections are used to restrain bleeding in 
cases of uterine fibroids, uterine cancer, and in the uterine haemorrhage 
dependent on spongy granulation of the mucous membrane. In every 
case of such use of styptic iron injections, it is essential, first, that air 
be not pumped into the uterine cavity, and second, that sufficient dila- 
tation of the cervical canal exist to permit ready exit to the surplus 
fluid and coagula. 

In albuminuria, connected with chronic changes of the kidney, iron 
is often very serviceable to improve the digestion, and to correct the 
anaemia, which is such an obvious feature of these maladies. The 
tincture of the chloride and the tincture of the acetate — especially the 
latter — are preferred, partly on account of their value as haematinic 
remedies, and partly because of their supposed diuretic action. When 
spermatorrhoea is dependent upon an impoverished condition of the 
blood, with relaxation of the vesiculae seminales, the tincture of iron 
is useful, but it is rarely of itself sufficient to effect a cure. The chalyb- 
eates are only harmful in those cases of nocturnal seminal losses which 
in the robust are merely significant of plethora. In gleet occurring in 
anaemic subjects, and in the prostorrhoea and catarrh of the urethra 
which arise from relaxation, the preparations of iron are useful 
adjuncts to other measures. I£ Tinct. ferri chloridi, 3 vj ; tinct. 
cantharidis, 3 ij. M. Sig. : Fifteen drops in water, three times a 
day. 

The sirup of iodide of iron is one of the most successful remedies 
in the nocturnal incontinence of urine in children. The precise indi- 
cations for its use are not evident. Sometimes belladonna succeeds 
better. It appears to the author that the iodide of iron is more useful 
in the case of pale, delicate, and strumous children, and belladonna in 
those who are more robust, the condition in the former being one of 



IRON. 135 

atony of the muscular wall of the bladder, in the other too ready con- 
traction from the reflex stimulation of acid urine. In these cases of 
incontinence of urine the sirup of the iodide should be given in doses 
of fifteen to twenty minims, well diluted with water, three times 
a day. 

Local Uses. — The styptic preparations of iron are frequently used 
to restrain haemorrhage. Leech-bites that bleed too profusely, haemor- 
rhage after extraction of teeth or in minor surgical operations, oozing 
from a large wounded surface, may often be checked by the use of 
Monsel's solution. 

As a topical application in gonorrhoea after the acute symptoms 
have subsided, in mucous cervicitis, in leucorrhoea, the styptic prepa- 
rations of iron are certainly useful, but a strong objection to their use 
arises from the staining of the clothing. 

Monsel's solution is an effective application to fissured nipples : 3 
Liquor f erri subsulphatis, 3 ij ; glycerini, 3 vj. M. Sig. : Apply with 
a camel's-hair brush to affected parts. Pure solution of subsulphate of 
iron will arrest the growth and. cause the exfoliation of syphilitic vege- 
tations of the glans and prepuce. 

Authorities referred to : 

Anstie, Dr. Francis E. Neuralgia and its Counterfeits, Macmillan & Co., London, 
1871, p. 181. 

Barker, Dr. Fordtce. Puerperal Diseases, New York, 1874, p. 183. 

Barnes, Dr. Robert. A Clinical History of Diseases of Women, London, 1873, p. 185. 

Buckxill and Tuke. Manual of Psychological Medicine, third edition, London, 1874, 
p. 764. 

Christisox, Dr. Robert. A Treatise on Poisons, Edinburgh, 1832, p. 573. 

Eulexburg, Dr. Albert. Lehrbuch der functionellen Nervenkrankheiten, Berlin, 1871, 
pp. 71, 198, 448, etc. 

Gubler, Dr. A. Commentaires Tlierapeutiques du Codex Medicamentarius, Paris, 186S. 

Hewitt, Dr. Grailt. ' Diseases of Women, second edition, London, 1868, p. 413. 

Jahresbericht uber die Fortschritte der Pharmacognosie, Pharmacie und Toxicologic, 
Gottingen, 1872, p. 237, art. Eisen. 

Ibidem, 1872, p. 523, Eisengelialt verschiedener vegetabilischer und thierischer Sub- 
stanzen. 

Lussaxa, Prof, vox Ph. Lo Sperimentale, October, 1872, Schmidt's Jahrbucher der 
gesammten Medicin, vol. clvi, p. 262. 

Nothxagel, Dr. Hermaxx. Handbuch der Arzneimittellehre, Berlin, 1870, p. 411, et seq. 

Pokrowsky, Dr. W. VirchovPs Archiv, vol. xxii. 

Squire, Peter. Companion to the British Pharmacopoeia, eighth edition, London, 1871. 

Taylor, Dr. A. S. On Poisons, third English edition, 1875, p. 484. 

Trousseau et Pidoux. Traite de Th'erapeutique et de Matiere Medicate, huitieme 
edition, art. Per. 

United States Dispensatory, thirteenth edition. 

Waldenburg und Simon. Handbuch der allgemeinen und speciellen Arzneivcrordnungs- 
Lehre, achte Auflage, 1873. 

Woronichix, Dr. X. Wien. med. Jahrbuch, xv, Schmidt's Jahrbucher der gesammten 
Medicin, vol. cxxxviii, p. 288. 



136 RESTORATIVE AGENTS. 

MANGANUM. 

Manganese. — Mangan, Ger. ; manganese, Fr. 

Mangani Oxidum Nigrum. — Black oxide of manganese. Dose, 
gr. ij — gr. x. In pill or powder. 

Mangani Sulphas. — Sulphate of manganese. In colorless or pale 
rose-colored transparent crystals, freely soluble in water. Dose, gr. 

ij— g r - ^ 

Unofficial preparations : 

Syrupus Ferri et Mangani Iodidi. — A pale straw-colored sirup. 
Dose, in, x — 3 ss. 

Ferri et Mangani Carbonas Sacch. — A tasteless, reddish-brown 
powder. Dose, gr. v — 3j. 

Syrupus Mangani Iodidi. — A sirup which corresponds in strength 
to the official sirup of the iodide of iron, and may be given in corre- 
sponding doses. 

Besides the above, a carbonate, phosphate, tartrate, malate, and lac- 
tate have been proposed for use, but hitherto they have not attracted 
attention and are rarely employed. The official and unofficial prepa- 
rations named above are all that, according to the present state of pro- 
fessional experience on the subject, will ever be required. It will be 
most convenient, however, to include with the manganic preparations 
the following : 

Potassii Permanganas. — Permanganate of potassa. In needle- 
shaped crystals of a deep purple color. It is soluble in sixteen parts 
of cold water, and the solution has a deep purple to a rose-color, ac- 
cording to the state of dilution of the salt. Dose, gr. ss — gr. ij. In 
prescribing the permanganate, distilled water free from organic matter 
should be directed. 

Physiological Actions. — The sulphate has an extremely disagree- 
able styptic and metallic taste ; the black oxide less so, and the saccha- 
rated carbonate is free from any taste except that of the sugar. The 
preparations of manganese are somewhat irritant to the gastrointesti- 
nal mucous membrane, and the sulphate is emeto-cathartic in full doses. 
There seems to be no doubt that the sulphate has a decided cholagogue 
effect, for very large discharge of bile is a result of its cathartic action. 
In small doses the manganic salts promote the appetite and digestive 
function. They probably enter the blood as albuminates. The inti- 
mate association of manganese with iron throughout the economy of 
Nature is exemplified in the human body. They are found together 
in the blood, hair, bile, biliary concretions, and renal calculi. The pro- 
portion of manganese to iron in the red blood-corpuscles is as one to 
twenty. As an essential constituent of the blood, it undoubtedly has 
to do with the constructive metamorphosis of the body. Used in large 
doses and for a considerable period of time it produces effects analogous 
to those of zinc — progressive wasting and feebleness, a staggering gait 



MANGANTTM. 137 

and paralysis (paraplegia). In toxic doses, according to the researches 
of Laschkewitsch, it causes in animals death by convulsions. In smaller 
doses it diminishes the pulse-rate, lowers the action of the heart, and 
lessens the blood-pressure. Like phosphorus, manganese induces acute 
fatty degeneration of the liver. When it is injected into the veins of 
animals, it causes tetanic cramp, dilatation of the pupil, exophthalmus, 
and death ; and after death the heart-muscle does not respond to elec- 
trical stimulation (Laschkewitsch). 

Antagonists. — The preparations of manganese are not incompat- 
ible with the vegetable astringents. The salts of lead, silver, and 
mercury, and the caustic alkalies, are chemically incompatible with 
manganese. 

Syneegists. — Iron is synergistic as regards hsematinic effects, and 
the salts of copper, silver, and zinc, as regards the effects on the 
nervous system. 

Theeapy. — Although manganese has not of itself been very useful 
in the treatment of anaemia and chlorosis, yet there is no doubt that 
its combination with iron much increases the efficacy of the latter. 
Some of the preparations named at the head of this article, especially 
the saccharated carbonate of manganese and iron, may be usefully pre- 
scribed in these diseases. Cachectic states arising from syphilis, can- 
cer, struma, gout, prolonged suppuration, chronic malarial infection, 
etc., are successfully treated by the sirup of the iodide of iron and 
manganese. 

Gastrodynia and pyrosis, according to Dr. Leared, are relieved by 
ten to fifteen grain doses of the black oxide — not the commercial article, 
but the oxide purified by washing with hydrochloric acid. In these 
disorders the effects of manganese are similar to those of bismuth 
(nitrate and carbonate), of zinc, and silver (oxide). Small doses of 
manganese (sulphate) may be usefully combined with iron and quinine 
when prescribed to promote constructive metamorphosis. 3 Quininse 
sulph., ferri sulph. exsic, mangani sulph. exsic, aa 3 j. M. Ft. pil. no. 
xx. Sig. : One pill three times a day. In jaundice of malarial origin, 
or from catarrh of the biliary passages, the author has seen excellent 
results from the use of manganese. I£ Chinoidin., 3 j ; mangani sulph. 
exsic, 3ij. M. Ft. pil. no. xx. Sig. : One three times a day in ma- 
larial jaundice. fy Fel. bovin. purif., 3 j ; mangani sulph. exsic, 3'\] ; 
resince podophylli, gr. v. M. Ft. pil. no. xx. Sig. : One three times a 
day in catarrhal jaundice. In the disordered digestion of gouty sub- 
jects, and to restore the activity of the assimilative functions after 
attacks of gout, manganese is most serviceable. 

Manganese (chloride) has been used by Osborne with success in 
hemorrhage (epistaxis), and the sulphate is one of the remedies for 
chronic rheumatism, neuralgia, cholera, and syphilis. 

An ointment of the oxide ( 3 ij — 5 j adeps suil.) has been used with 



138 RESTORATIVE AGENTS. 

advantage in tinea, scabies, and other chronic shin-diseases. ^ Man- 
gani oxid., sulphuris, saponis dur., aa 3 j ; adipis suilli, 1 iij. M. Oint- 
ment for porrigo. 

Actions and Uses of the Permanganate of Potassa. — This salt is a 
very powerful oxidizing agent, and yields up its oxygen readily in the 
form of ozone. Its use as an internal and external remedy is based on 
this chemical fact. That it parts with its oxygen so readily is held by 
some to demonstrate its entire inutility when administered by the 
stomach. Although it must instantly be decomposed on reaching the 
stomach, there are satisfactory reasons for believing that it exerts a 
favorable influence on certain diseases in which, theoretically consid- 
ered, it may be indicated. The author has seen marked advantage 
from its use in the dyspepsia and flatulence so constantly attendant on 
obesity. It has also ajmeared to be very serviceable as a remedy for 
an abnormal and excessive deposition of fat. In the so-called uric-acid 
diathesis it favors the conversion of uric acid into urea, and thus pre- 
vents the formation of uric-acid calculi. Pain in the lumbar region, 
frequent micturition, acid urine, much brick-dust sediment, and intes- 
tinal indigestion, are associated symptoms relieved by the perman- 
ganate. Under the same conditions, it is probable acute rheumatism 
is developed, and to the action of the permanganate as an oxidizing 
agent is attributable the benefit which is sometimes obtained from its 
use in this disease. In scarlatina and diphtheria the permanganate is 
used with undoubted benefit, applied to the throat and taken by the 
stomach. In erysipelas, puerperal fever, septicaemia, it has been given 
with advantage. Lately it has been used with success as a remedy 
for the bites of venomous snakes and other animal poisons, applied 
locally and given internally. Drs. Ringer and Murrell have found 
it an effective remedy in the treatment of amenorrhoea, one or two 
grains being given in pill form three times a day. It is difficult to 
prepare the pills, and they are said to be liable to spontaneous com- 
bustion. For internal use the permanganate is best administered in 
pure distilled water, and the bottle containing the solution should be 
glass-stoppered. The dose for internal use is gr. £ — gr. ij ter die. 

Among the important uses of permanganate of potassa are its ex- 
ternal applications as a disinfectant. It is a deodorizer as well as a 
disinfectant. It is very frequently used ( 3 j — Oj) to correct the fetor 
of cancer, ulcers, caries, abscesses, etc. It is used as an injection, or in 
the form of spray, to destroy the odor of the discharges and to alter 
the morbid action, in cases of ozcena, otorrhoea, etc. It is an elegant 
toilet preparation (gr. j — 1 j) for destroying the odor of a foul breath, 
the smell of the axilla, and the fetor of the sweat of the feet. Its action 
is not lasting, and the effects must be maintained by frequent appli- 
cations. 

The permanganate of potassa iu solution (gr. ij — 1 j) is one of the 



CHALYBEATE SPRINGS. 139 

numerous remedies prescribed in gonorrhoea and leucorrhoea, but it has 
no special advantages in these maladies. 

When the permanganate is deoxidized it loses its rich purple 
color, becomes a dull red, and is reduced to the state of binoxide 
of manganese. 

Authorities referred to : 

Hermann, Dr. L. Lehrbuch der experimentellen Toxicologic, Berlin, 1874, p. 195. 

Laschkewitsch, W. Vergleichende Untersuchungen uber die Wirkung dcr Mangan- 
und Eisensalze. Medicinische Centralblatt, 1866, No. 24. 

Stille, Dr. Alfred. Therapeutics and Materia Medica, fourth edition, Philadel- 
phia, 1874. 

Trousseau et Pidoux. Traite de Therapeutique et de Maiiere Medicate, huitieme 
edition, Paris, 1868, vol. i, p. 59. 

CHALYBEATE MINERAL SPRINGS. 

1. Noeth Amebic an. 

Bailey Springs, Lauderdale County, Alabama. 

These springs contain carbonates of potassa, soda, magnesia, car- 
bonic-acid gas, oxide of iron, etc. 

Rawley Springs, Rockingham County, Virginia. 

Carbonate of iron (0*203 grain) is the most important ingredient in 
these waters. They contain, also, carbonates of manganese, magnesia, 
lime, and lithia, and sulphates, etc. 

Sweet Chalybeate Springs, Alleghany County, Virginia. 

The name of this water is derived from its sweetish taste. It is 
highly charged with carbonic-acid gas, and contains sesquioxide of 
iron, with sulphate of lime (4*110 grains), sulphates of magnesia and 
soda, and chlorides of lime, sodium, magnesium, etc. 

Rockbridge Alum Springs, Rockbridge County, Virginia. 

Bath Alum, Bath County, Virginia. 

These waters are remarkable for containing free sulphuric acid. 
They contain also sulphates of magnesia and lime, protoxide of iron, 
and carbonic- acid gas. The Bath Alum waters contain twice as much 
iron as the Rockbridge Alum. 

Bedford Alum Springs, Bedford County, Virginia. 

Similar in composition to the above, but contain a larger proportion 
of iron, and of the salts of potassa, magnesia, and lime. 

Bedford Springs, Bedford County, Pennsylvania. 

This water contains carbonate of iron (0*625 grain) associated with 
a large proportion of sulphate of magnesia (10 grains), and is, there- 
fore, a laxative chalybeate. 

2. ElJEOPEAN. 

Bascombe, Bournemouth, Hampshire, England. 

Chalybeate springs containing carbonic acid in combination. 



140 RESTORATIVE AGENTS. 

Dorton, Buckinghamshire, England. 

Contains sulphate of iron and is charged with carbonic acid. Re- 
quires dilution for drinking. 

Hastings, Sussex, England. 

Contains sulphates of iron, magnesia, lime, and soda. 

Sandrock, Isle of Wight. 

Is a strong aluminous chalybeate — 41^ grains of sulphate of iron, 
and 31^ grains of sulphate of alumina in twenty ounces — and therefore 
requires dilution for drinking. 

Tunbridge, Kent, England. Altitude, 289' ; temperature, 50° Fahr. 

This water contains one eighth of a grain of iron with carbonic 
acid, in twenty ounces. 

Spa, Belgium. Altitude, 1,030'. Season, August and September. 
Temperature of water, 52° Fahr. 

These waters contain carbonates of iron, manganese, soda, lime, and 
magnesia, etc., and are highly charged with carbonic acid. 

Pyrmoilt, Waldeck. Altitude, 404' ; mean annual temperature, 
48-5° Fahr. 

The quantity of carbonic-acid gas is unusually great in these waters. 
They contain sulphates of lime, soda, magnesia, and carbonates of iron, 
soda, magnesia, and lime. 

Alexisbad, near Harzgerode, Germany. 

Alexisbrunnen. Same. 

Both contain iron and manganese in large quantity, and also car- 
bonic-acid gas. The first named, being highly impregnated with chloride 
and sulphate of iron, is used for bathing, and the other for drinking. 

Schwalbach, Nassau. Altitude, 909'. Season, June to September. 
Temperature, 64° Fahr. 

According to the analysis of Fresenius, this valuable water contains 
bicarbonates of iron, manganese, soda, magnesia, and lime, sulphates of 
soda and potash, and chloride of sodium. It is very highly charged 
with carbonic acid. 

St. Muritz, Upper Engadin, Switzerland. Altitude, 5,464'. Mean 
temperature of summer months, 51° Fahr. 

These springs contain from ten to fourteen grains of solids in a 
pint, consisting of carbonates of lime, magnesia, manganese, iron, and 
soda, etc., and as much as 39'5 cubic inches of carbonic acid. 

Therapy of Chalybeate Waters. — The uses of these waters are 
the same as the purely medicinal preparations of iron. They are in- 
dicated in chlorosis and anaemia, to supply to the blood the material 
in which it is deficient. For this purpose the milder waters, contain- 
ing carbonate of iron and abundant carbonic acid, are most suitable ; 
for example, in this country, Rawley Springs, Sweet Chalybeate, Bed- 
ford (Pennsylvania) ; in England, Bascombe and Tunbridge ; on the 
Continent, Pyrmont, Spa, Schwalbach, St. Moritz. When passive hmm- 



BISMUTH. 141 

orrhages — the hemorrhagic diathesis — require ferruginous waters, the 
alum and iron waters are more effective. Amenorrhea, hysteria, 
and other pelvic disorders, when dependent on anaemia, the paludal 
cachexia, leucocythemic-exophthalmic goitre, are either cured or de- 
cidedly ameliorated by chalybeate waters. 

The purgative iron waters are useful in engorgement of the liver, 
haemorrhoids, and dyspepsia of ancemic subjects, in albuminuria and 
dropsy ; the alum springs in chronic diarrhoea and strumous diseases. 

Neuralgia, chorea, cerebral anaemia, and other nervous disorders 
due to an impoverished condition of the blood, are much improved by 
the use of the milder chalybeate waters. 

In making selection of a chalybeate water, the psychical influences 
of mountain scenery, or other pleasant surroundings, should not be dis- 
regarded. For the anaemic pulmonary invalid, elevation of the spring 
and the absence of humidity are important considerations to determine 
a selection. Hence, the present popularity of St. Moritz. In this coun- 
try a great variety is afforded — mountain scenery like Bedford, Penn- 
sylvania, and the Virginia springs, or rolling upland like Bailey's and 
Sharon. As respects composition, the ferruginous springs of the United 
States are equal to any in the world. 

For authorities referred to, see articles on Alkaline and Saline 
Springs. 

None of the remedies heretofore considered, contained in the group 
of agents promoting constructive metamorphosis, are foreign to the 
organism. They are all necessary to and directly promote the forma- 
tion of the blood and tissues. 

In the same group, however, are remedies which, while they are 
tonic and reconstituent, do not enter into the composition of the 
body. They promote, in an indirect way, the constructive metamor- 
phosis. Among these are bismuth, arsenic, the simple bitters, cinchona 
and its alkaloids. These agents having performed their office, are, 
after a variable period, eliminated from the organism. Their thera- 
peutical effects can not be entirely comprehended in the process of 
constructive metamorphosis, and in the ultimate results of their physi- 
ological actions the destructive metamorphosis may be included. 



BISHUTHUM. 

Bismuth. — Bismuthi subcarbonas. — Subcarbonate of bismuth. A 
white or yellowish- white powder, without taste or smell, insoluble in 
water. Dose, gr. x — 3 j, in powder or emulsion. 

Bismuthi Subnitras. — Subnitrate of bismuth. A heavy, white pow- 



142 RESTORATIVE AGENTS. 

der, with a faintly acid odor and taste, insoluble in water. Dose, gr. 
x — 3 j, in powder or emulsion. 

Bismuthi Citras. — Citrate of bismuth. "A white, amorphous pow- 
der, odorless and tasteless, insoluble in water or alcohol." Dose, gr. 
v— 3j. 

Bismuthi et Ammonii Citras. — Citrate of bismuth and ammonia. 
Small translucent scales, soluble in water. Dose, gr. v — gr. xv. 

Besides these official preparations, various compounds of bismuth 
are prescribed. None of these present any advantages over the official 
forms, and most of them are objectionable from various considerations. 
The solutions of bismuth do not produce the effects of the insoluble 
subcarbonate and subnitrate, and the various trade preparations con- 
taining bismuth and pepsin, bismuth and strychnine, bismuth and cali- 
saya, etc., are, to the last degree, unscientific and unreliable. 

Physiological Actions. — The insoluble preparations have a very 
slightly metallic taste. They coat the tongue black by the formation 
of a sulphide. Given in suitable cases, they promote the appetite and 
increase the digestive power, and a gain in body-weight is one result 
of their administration. They are somewhat astringent, and retard the 
intestinal movements. As they are nearly insoluble, they pass dcwn 
the intestinal tract and are converted into sulphides ; hence the faeces 
under their use become a dark slate color. They are not entirely in- 
soluble, for bismuth can be detected in the blood, urine, and other 
secretions, after a course of these medicines. Sufficient is absorbed 
under some circumstances, it is said, especially after prolonged admin- 
istration, to cause toxic symptoms ; but such a result must be due to 
accidental combinations, or to the presence of arsenic, which is a very 
constant impurity in the ordinary commercial preparations of subni- 
trate and subcarbonate of bismuth. Trousseaux and Pidoux remark, 
with regard to its presumed toxic effect, as follows : " When the sub- 
nitrate of bismuth has been prepared from the perfectly pure metal, 
precipitated and well washed, it may be given in single doses from one 
to four grammes (fifteen grains to a drachm) without producing the 
least malaise" According to the same authority, Dr. Monneret has 
often given as much as ten to sixty grammes a day, without any recog- 
nized ill effects. It may, therefore, be concluded that the action of 
bismuth is chiefly local. 

Therapy. — In the aphthm of children, nursing sore-mouth, the 
milder cases of mercurial salivation, and in those painful ulcers of 
the mucous membrane of the mouth due to disorders of digestion, bis- 
muth applied freely to the affected parts is often very serviceable, by 
diminishing the pain and promoting the healing process. Bismuth 
allays the irritability of the mucous membrane in cases of acute indi- 
gestion, if given after the contents of the stomach are fully evacuated. 
It is especially indicated when there is not only painful digestion, but 



BISMUTH. 143 

a tendency to diarrhoea, the inclination for stool coming on soon after 
the food has been taken. It is given with great advantage in subacute 
and chronic gastritis, and in gastralgia arising from a state of irrita- 
tion of the gastric mucous membrane. It is contraindicated, and is 
not beneficial, in the gastralgia produced by habitual constipation and 
in the gastralgia of chlorosis and hypochondria. The pain and vomit- 
ing attendant on gastric ulcer and scirrhus of the stomach are relieved 
by bismuth, and in the case of the former disease this remedy con- 
tributes to the cure. In these painful affections, the good effects of 
the bismuth are enhanced by combination with morphine. P> Bismuthi 
subnitrat., 3 ij ; morphines sulphat., gr. j. M. Ft. pulv. no. vj. Sig. : 
One three times a day in milk. When morphine is, from any cause, in- 
admissible, hydrocyanic acid may be given in a mixture with bismuth. 
t> Bismuthi subnitrat., 3 ij ; acid, hydrocyan. dil., 3 ss ; mucilag. acacias, 
aquas menthas pip., aa § ij. M. Sig. : A tablespoonful three times a 
day. Although arsenic as an impurity is so objectionable that special 
pains are taken in the pharmaceutical process to separate it in the 
preparation of subnitrate, yet the author has witnessed excellent re- 
sults from a combination of arsenic and bismuth in the more chronic 
stomach-disorders for which the latter is prescribed. 

When bismuth is not well borne by the stomach, it may be com- 
bined with aromatic powder, or, when alkalies are indicated, it may 
be given with chalk or magnesia. When constipation is produced by 
it, bismuth can be administered with rhubarb or magnesia. 

Bismuth is one of the remedies most frequently employed in the 
treatment of the vomiting of teething children, cholera infantum, and 
summer diarrhoea. Numerous combinations are employed : with pep- 
sin, when these disorders appear to depend on the condition known as 
apepsia, the discharges containing masses of undigested casein ; with 
rhubarb, when the symptoms are produced by undigested aliment, or 
when the stools are white and pasty ; with soda and chalk, when the 
stools are acid and excoriate the buttocks. In cases of vomiting of 
pregnancy, the vomiting of teething children, acidity, and pyrosis, ex- 
cellent results are sometimes obtained from bismuth and carbolic acid. 
r> Bismuthi subnitrat., 3 ii ; acid, carbol., gr. ij — gr. iv ; mucil. acacias, 
3 j ; aquas menthas pip., § iij. M. Sig. : A tablespoonful for adults 
and a proportionate quantity for children three or four times a day. 

The diarrhoea of typhoid fever is restrained by bismuth in scruple 
to half-drachm doses. In chronic diarrhoea large doses of bismuth 
are beneficial and often curative, but thirty to sixty grains must be 
given every three or four hours. Equally large doses check the diar- 
rhoea of phthisis. In these doses, bismuth not only restrains the in- 
testinal discharges, but improves the appetite and the digestion. 

Bismuth is employed for a variety of purposes in the treatment of 
external maladies. It is a good application to the reddened surface of 



144 RESTORATIVE AGENTS. 

the skin in cases of acne rosacea, and may be used as a cosmetic in 
this mortifying disease. The author has seen excellent results from 
the free application of bismuth in cases of eczema when there was 
much serous exudation. Under the crusts thus formed healing pro- 
ceeded satisfactorily. In intertrigo and in the erythema which occurs 
about the genitals of infants, dusting the affected surface with bis- 
muth soothes the j)ain and promotes healing. Bismuth is one of the 
numerous applications to the eye in cases of chronic conjunctivitis and 
granular lids. It is also used as an injection, mixed with mucilage, or 
with cocoa-butter in the form of a suppository, in chronic gonorrhoea 
and in gleet, and in leucorrhoea. fy Bismuthi subnitrat., gr. vj ; hy- 
drarg. chlor. cor., gr. ss ; tinct. camphorae, ttl jss ; aquae ad § j« M. 
Lotion for skin-diseases. 

The best vehicle for the administration of bismuth is milk. It 
should be given before meals as a rule when employed in stomach-dis- 
orders. 

Authorities referred to : 

Fox, Dr. Wilson. The Diseases of the Stomach, LondoD, 1872, pp. 93, 94, 139, 1*79, 
203, etc. 

Nothnagel, Dr. Hermann. Handbuch der Arzneimittellehre, Berlin, 1870, p. 297, 
et seq. 

Squire. Companion to the British Pharmacopoeia, eighth edition, p. 58. 

Stille, Dr. Alfred. Therapeutics and Materia Medica, vol. i, p. 183. 

Trousseau et Pidoux. Traite de Therapeutique et de Matiere Medicate, vol. i, p. 200. 

Waldenburg und Simon. Handbuch der allgemeincn und speciellen Arzneiverordnungs- 
Lehre, Berlin, 1873, p. 195, et seq. 

ARSENICUM. 

Arsenic. — Acidum arseniosum ; arsenious acid; acide arsenieux, 
Fr. ; Arsenige Saure, Ger. Dose, -^ — -^ grain. 

Arsenii Iodidum. — Iodide of arsenic. Is an orange-red, crystal- 
line solid, entirely soluble in water, and wholly volatilized by heat. 
Dose, gr. ^. 

Liquor Acidi Arseniosi. — Solution of arsenious acid. Dose, tt[ 
ij— v. 

Liquor Arsenii et Hydrargyri Iodidi. — Solution of iodide of ar- 
senic and mercury ; Donovan's solution. Dose, tti ij — v. / 

Liquor Potassii Arsenitis. — Solution of arsenite of potassium ; 
Fowler's solution. (Arsenious acid, bicarbonate of potassium, com- 
pound spirit of lavender, and distilled water.) Dose, Tq, ij — x. 

Liquor Sodii Arseniatis. — Solution of arseniate of sodium ; Pear- 
son's solution. Dose, tti ij — xx. 

Arsenic in solution is better for internal administration than the 
solid arsenious acid, and, of the three solutions (official) mentioned 
above,, Fowler's is the best. Arsenious acid, when administered in 



ARSENIC. 145 

the solid form and at short intervals, may act with unexpected vio- 
lence. 

When a course of arsenic is begun, large doses should be pre- 
scribed, and the quantity administered should be regularly reduced. 
In this way chronic arsenical poisoning is avoided. When continually 
increasing doses are given, the arsenic accumulates, and toxic symp- 
toms are quickly induced. As a rule, unless very small doses are pre- 
scribed, arsenic should be taken after meals. Some subjects are soon 
seriously affected by even small doses of arsenic. For this reason, 
when the idiosyncrasies of the patient are unknown, it were better to 
make tentative experiments with a few small doses before beginning 
with large ones. A few drops of laudanum given with arsenic will 
enable it to be better borne by some susceptible subjects. 

Antagonists and Incompatibles. — The salts of iron, magnesia, 
and lime, and astringents, are chemically incompatible. The arseniate 
of iron, although not actively so, does cause toxic symptoms if con- 
tinued in full medicinal doses. The hydrated sesquioxide of iron, 
freshly precipitated) and in a soft magma, is the antidote to arsenic in 
solution. About eight grains of the antidote are required for each 
grain of the poison swallowed. As the hydrated sesquioxide of iron 
is harmless, it should be given in teaspoonful to tablespoonful doses, 
every few minutes. In every case of poisoning by arsenic, prompt 
efforts to secure evacuation of the contents of the stomach are neces- 
sary. Large doses of the antidote may be given with the emetic em- 
ployed. In the absence of the hydrated sesquioxide of iron, magnesia, 
chalk, and lime-water may be given freely. These agents act in part, 
and probably chiefly, mechanically, by enveloping the particles of ar- 
senic, and so hindering absorption. It is held by some that freshly 
precipitated hydrate of magnesia is more effective as an antidote than 
the hydrated sesquioxide of iron. Large draughts of oil, milk, and 
substances containing mucilage, by protecting the mucous membrane, 
render important service in cases of arsenical poisoning. Dialyzed 
iron, later experiences show, is quite as efficient as the hydrated sesqui- 
oxide, and is always ready. It is an important point to favor rapid 
elimination of the poison when the patient survives the acute symp- 
toms. This is accomplished by the use of diluent drinks, skimmed 
milk, slightly alkaline mineral waters, etc. 

Synergists. — All those agents which promote constructive meta- 
morphosis are synergistic to arsenic. 

Physiological Actions. — Applied to the tissues, arsenic excites 
violent inflammation and causes destruction of the part ; it is, there- 
fore, an escharotic. Great pain attends its action. In consequence of 
the high degree of inflammation which it excites, when applied in suf- 
ficient strength, absorption does not follow its local use, but weak ap- 
plications may excite dangerous symptoms by diffusion into the blood. 
10 



146 RESTORATIVE AGENTS. 

Symptoms of poisoning follow the inhalation of arsenical fumes. 
Numerous instances have occurred in which wall-papers colored with 
arsenical pigments have poisoned the occupants of an apartment. Gar- 
ments covered with aniline dyes, fixed by arsenical mordants, have 
induced local ulcerations and systemic symptoms from absorption of 
arsenic. Applications to a large portion of even the unbroken integu- 
ment, and to ulcerated surfaces, have, in numerous instances, excited 
dangerous symptoms, and have produced fatal results. That arsenic, 
wherever applied, manifests a selective action on the mucous mem- 
brane of the respiratory and digestive tracts, is a curious fact. 

Arsenic, in small medicinal doses, promotes the appetite and diges- 
tive functions, and improves the body nutrition. It increases secretion 
of the gastro-intestinal mucous membrane, and hastens the peristaltic 
movements. Arsenic diffuses into the blood with facility. It probably 
enters into combination with the red blood-globules. It certainly 
lessens the excretion of carbonic acid, probably also of urea ; in other 
words, it checks the retrograde metamorphosis. It stimulates the 
cerebral functions and induces a feeling of well-being, and in some 
subjects decided mental exhilaration. 

In larger doses, yet not in quantity to produce acute poisoning, and 
when full medicinal doses have been administered for a lengthened 
period, arsenic causes more characteristic physiological actions than 
are described above. As regards the digestive organs, the following 
phenomena occur : A metallic taste ; increased flow of saliva ; nausea, 
vomiting of glairy mucus, epigastric pain, and soreness ; diarrhoea, 
tenesmus, and sometimes dysenteric stools. As regards the circulatory 
and respiratory organs : the action of the heart becomes irritable and 
feeble, palpitations, cough, oppressed breathing, oeclema of the eyelids, 
general oedema, and albuminuria occur. As regards the skin : itching 
of the eyelids, urticaria, eczema, pityriasis, psoriasis, and falling out 
of the nails and hair. As regards the nervous system : disorders of 
motility — trembling, stiffness, and contraction of the joints, disorders 
of sensibility, herpes zoster. 

Notwithstanding the effects above described are so frequently ob- 
served to follow the use of arsenic, it is undoubtedly true that a cer- 
tain degree of tolerance may be established when doses in themselves 
toxic can be taken with impunity. This state has been produced in a 
course of the legitimate administration of arsenic, and has been wit- 
nessed on a considerable scale among the arsenic-eaters of Styria and 
Southern Austria. The arsenicophagi begin the habit of arsenic-eat- 
ing at an early age, and become habituated to the use of enormous 
doses. They find that this practice is serviceable in several respects : 
they improve in bodily condition, gain in breathing-power, and be- 
come stronger and more pugnacious, and also more salacious. 

Wben arsenic is swallowed in sufficient quantity to cause the symp- 



ARSENIC. 147 

torns of acute poisoning, the phenomena produced are of two kinds — 
gastro-intestinal irritation and cerebral effects. The former is much 
the more common. The following are the symptoms of the gastro-in- 
testinal form of acute arsenical poisoning : Burning at the epigastrium 
and radiating thence over the abdomen ; violent and uncontrollable 
vomiting ; great dryness of the mouth and fauces ; intense thirst ; 
intestinal irritation, bloody and offensive stools, retracted abdomen ; 
strangury, priapism, suppression of urine or bloody urine, and in fe- 
males menorrhagia ; rapid and feeble action of the heart, oppressed 
breathing ; great agitation and restlessness ; shrunken features, cold 
breath ; involuntary evacuations ; collapse — consciousness being re- 
tained to the last. In the cerebral form of acute poisoning, without 
any symptoms of gastro-intestinal irritation, the patient is suddenly 
put into a condition of profound insensibility and coma, not unlike 
extreme opium narcosis. 

Recovery from the effects of acute arsenical poisoning is rarely 
complete. For a long time afterward a considerable degree of gastro- 
enteric irritability will persist, and life may at last be lost from the 
continued operation of this pathological state on the function of nu- 
trition. An irritable state of the skin and stiffness of the joints may 
also continue for some time, and paralysis may supervene, accompa- 
nied with neuralgic pains, numbness, formication, etc. 

The changes found after death in the gastro-intestinal mucous 
membrane are those due to an irritant : deep redness, erosions, ecchy- 
moses, and softening. These alterations are also produced when toxic 
effects are caused by the external application of arsenic. More or less 
redness of the tracheal and bronchial mucous membrane and conges- 
tion of the lungs have been observed. It must not be forgotten that 
arsenic has caused a fatal result without producing any gastro-intesti- 
nal lesions except some uncharacteristic redness. Fatty degeneration 
of the liver, kidneys, spleen, and other organs, has been observed in 
cases of acute poisoning, even when the symptoms have existed for a 
few hours. The icterode hue of the skin and the albuminuria which 
occur in the course of chronic arsenical poisoning are probably due to 
fatty degeneration of the liver-cells and of the renal epithelium. 

Arsenic, although like other mineral poisons it tends to accumulate 
in the system, is nevertheless eliminated with considerable rapidity. 
If the patient survive a week after the ingestion of a toxic dose, it is 
difficult to detect it in the body after death. If the poison is retained 
and death ensues before elimination can take place, it undoubtedly re- 
tards putrefaction. Arsenic is eliminated by various organs — by the 
liver, intestinal canal, kidneys, and bronchial tubes — and some of the 
symptoms produced by it probably have their origin in the local effect 
of the poison on the channels of excretion. 

The quantity of arsenic required to produce a fatal effect varies ac- 



148 RESTORATIVE AGENTS. 

cording to the state of the stomach and the susceptibilities of the pa- 
tient. Ounces have been swallowed without producing even serious 
symptoms, because promptly rejected by vomiting. When the stom- 
ach is full of food, absorption is slow and vomiting is easily induced, 
and hence a toxic dose may not under these circumstances produce 
any of the phenomena of poisoning. A half -grain of arsenious acid 
has caused symptoms of poisoning (Taylor), and, according to the 
same authority, from two to four grains may prove fatal to an adult. 
Much depends on the idiosyncrasies of the individual, which, as has 
been stated above, differ greatly in different persons. These facts 
should not be forgotten in prescribing strictly medicinal doses of ar- 
senical preparations. 

From this general survey of the effects of arsenic, we may properly 
proceed to study the results of more minute investigations. Yirchow 
has pointed out the similarity in the post-mortem appearances of arsenic 
and of cholera. The cholera-fungus of Klebs and the characteristic 
rice-water contents of the intestinal canal were not wanting to com- 
plete the resemblance. Hoffman has since fully confirmed these ob- 
servations. Croupous exudations are sometimes encountered in the 
stomach and intestines, and crystals of arsenic have been found im- 
bedded in the false membrane. This result is due to the action of 
arsenic when swallowed in powder, and is not produced w T hen the 
poison is taken in solution (Filehne, Lesser). The gastro-intestinal in- 
flammation, present in a large proportion of cases, is due in part to the 
local action of the arsenic, in part to its selective action, but this fact 
does not justify the statements of Bohm and Unterberger that a larger 
dose of the poison is required to destroy life by the intravenous injec- 
tion than by the stomachal administration. Lesser holds with the 
authorities in general that arsenic, in common with other poisons, is 
more fatal by intravenous injection. In a small proportion of cases, 
as has been stated, gastro-intestinal inflammation does not occur, but 
the effects of the poison are expended on the nervous centers ; several 
hours after the ingestion of a large dose, delirium, followed by coma, 
and convulsions come on, and with these albuminuria, occasionally 
urinary suppression. The relation of the attacks of eclampsia to the 
albuminuria has not been settled. In still other cases the gastro-intes- 
tinal disturbance, the rice-water discharges, the collapse, simulate the 
algid stage of cholera. The remarkable fall in the blood-pressure of 
the abdominal vessels produced by arsenic certainly throws light on 
these phenomena (Bohm and Unterberger). 

The experiments of Sklarek have demonstrated that arsenic decid- 
edly impairs sensibility, leaving the motor functions untouched. In 
the human subject, however, as the result of acute poisoning, and 
sometimes after the acute symptoms have subsided, certain paralyses 
develop. They may be preceded by numbness and tingling, and may 



ARSENIC. 149 

be accompanied by contractures which disappear in curable cases, and 
remain permanently in incurable cases. The paralysis may be limited 
to a single member, and when several are thus affected the usual form 
of paralysis is paraplegia ; but all four members may be thus disabled. 
The rectum and bladder are not affected (Christison). These clinical 
observations by Christison are confirmed by the researches of Ringer 
and Murrell, who have shown that Sklarek's statements were incorrect, 
and that motor paralysis precedes sensory paralysis in the frog poi- 
soned by arsenic. (See Ponteland Poisoning Cases, " Lancet," Sep- 
tember, 1866.) 

The effects of arsenic on the circulation are not the same in cold 
and warm blooded animals, for, according to Sklarek, in the former 
the action of the heart is slowed, then arrested, while in the latter the 
action of the heart persists after the cessation of respiration (Bohm 
and Unterberger, Lesser). This fundamental difference in the action 
of arsenic on the two classes of animals requires us to accept with 
caution the observations made on the vaso-motor system of the cold- 
blooded. It has been pretty definitely ascertained that arsenic causes 
a fall in the blood-pressure, which is especially strong in the abdomi- 
nal blood-vessels (Bohm and Unterberger). 

A fact of great importance, first ascertained by Saikowsky, is the 
fatty degeneration of the liver, kidneys, heart, and other organs. The 
case of Grohl and Mosler, reported in the same volume of Virchow's 
" Archiv " containing Saikowsky's paper, is confirmatory more or less 
completely of the observations in the latter. They found, as their 
figures well exhibit, fatty degeneration to a greater or less extent in 
the glandular epithelium of the intestinal canal, and less conspicuous 
evidences of the same change in the kidneys, the liver, and the muscu- 
lar tissue of the heart. As the extent of the change is determined 
largely by the duration of the case, when death occurs in a few hours, 
or in a day or two, little alteration is discernible. 

The effect of arsenic on the function of nutrition is as yet involved 
in doubt. It is a recognized fact that arsenic promotes constructive 
metamorphosis when administered in medicinal doses. It has been 
ascertained by Saikowsky that it arrests the formation of glycogen by 
the liver, and C. Schmidt has shown that it lessens the excretion of 
carbonic acid and urea. Although doubt has been thrown on these 
statements, they seem to be supported by the observations of Lesser 
on the temperature, which has been constantly and considerably de- 
pressed under the action of lethal doses. The effect of arsenic in 
lowering the functional activity of the respiratory center is a fact 
which supports the same view, for a diminution in the quantity of oxy- 
gen admitted to the blood must necessarily lessen the rate of oxidation. 
On the other hand are the adverse experiments of Kassel, a medical 
student under Prof. Gathgens, and Gathgens himself, which appar- 



150 RESTORATIVE AGENTS. 

ently demonstrate an actual increase in the amount of urea excreted. 
Arsenic has an anti-fermentative action ; but it is not universally 
destructive of the minute organisms on th& presence of which the 
various fermentations are dependent. Thus it is poisonous to Torula 
cerevisice and to some micrococci, but not to all, and it does not impair 
the activity of certain animal ferments, as pepsin, pancreatin, etc. 
(Johannsohn, Schafer, and Bohm). On the trophic system it acts as 
a depressant when taken in considerable quantity. The dust from 
arsenical wall-papers has induced a cachectic state, accompanied by 
headache, vertigo, and tinnitus (Donkin). Aniline dyes fixed by a 
mordant of arsenic have excited ulceration of the nails, phlegmon of 
the hands, and anaesthesia and paresis of the extremities (Clemans). 

Therapy. — The preparations of arsenic are applicable to the treat- 
ment of the diseases of those tissues upon which it has a selective ac- 
tion. 

"No remedy is more useful than arsenic in the so-called irritative 
dyspepsia, manifested by these symptoms : a red and pointed tongue, 
poor appetite, distress after meals, the presence of the food causing 
intestinal pain, colic, and the desire to go to stool. Drop-doses of 
Fowler's solution, given before meals, quickly relieve this state of 
things. The effects of the arsenic are frequently favored by the con- 
joint administration of a little laudanum. 

In some cases of the vomiting of pregnancy, a drop of Fowler's 
solution given before each meal will afford astonishing relief. The 
particular indications for its use are these : vomiting of food, followed 
by retching and straining, the vomited matters being streaked with 
blood, or blood alone being thrown up ; these symptoms accompanied 
by gastralgia and pain between the scapulae. 

The vomiting of chronic gastric catarrh, especially the alcoholic 
form, is relieved by one or two drops of Fowler's solution taken before 
meals. It effects a cure in these cases by relieving the morbid state 
of the mucous membrane on which the vomiting depends. Arsenic is 
also very beneficial in these small doses in chronic ulcer of the stomach. 
It checks the vomiting, relieves the pain, and improves the appetite 
for food. It is not equally effective in the acute ulcer. Although ar- 
senic exercises but little influence over the progress of these cases, it 
is very serviceable in cancer of the stomach, by diminishing the pain 
and checking the vomiting. Gastralgia and enteralgia, when idio- 
pathic, are sometimes made to disappear in a very surprising manner 
by the same remedy, but there are no certain indications of the kind 
of case to which it is best adapted. 

In the treatment of stomach-disorders, only small doses of arsenic 
are admissible. Large doses, by creating an irritation of the gastric 
mucous membrane, will only defeat the end in view. 

That form of diarrhoea which consists merely in an intolerance of 



ARSENIC. 151 

the presence of food, an evacuation of the undigested aliment taking 
place soon after it is swallowed, is cured by arsenic. Chronic diar- 
rhoea and dysentery (entero-colitis), especially when dependent on 
the changes induced by chronic malarial infection, are often greatly 
benefited by the same remedy. In these cases, two drops of Fowler's 
solution with five drops of laudanum should be given before meals. 
Attention to the diet is, of course, imperative. Constipation, when 
due to deficient secretion and dryness of the faeces, is sometimes over- 
come by small doses of Fowler's solution. 

Arsenic is one of the numerous remedies proposed for the treat- 
ment of epidemic cholera. It is a curious circumstance, first demon- 
strated by Virchow, that some cases of acute arsenical poisoning are 
not distinguishable by their symptomatology or morbid anatomy from 
cases of epidemic cholera. 

Arsenic has been used with success in the treatment of the jaun- 
dice due to catarrh of the bile-ducts succeeding to catarrh of the 
duodenum. It seems to the author to be better adapted to cases of 
jaundice of malarial origin. Excellent results are obtained by the 
persevering use in small doses of arsenic in cirrhosis. As arsenic 
tends to accumulate in the liver, and as it produces fatty degeneration 
of this organ, the curative effect in the above-named disorders may 
depend on this selective action. 

There is no doubt that arsenic promotes in a very decided manner 
the constructive metamorphosis. It is one of the most valuable agents 
which we possess in the treatment of chlorosis and anaemia. It is es- 
pecially adapted to those cases in which iron does not agree or fails of 
effect. The efficiency of iron in these disorders is much increased by 
combination with arsenic. 

Cases of acute coryza and hay-asthma are often decidedly relieved 
by this remedy. Chronic catarrh of the broncho-pulmonary mucous 
membrane, emphysema, sclerosis of the lungs, are maladies in which 
arsenic, long used in ordinary medicinal doses, is capable of effecting 
considerable amelioration. We have no single drug of equal utility 
in the chronic forms of fihthisis, but it is not serviceable in caseous 
pneumonia. It is said, and this statement corresponds to the author's 
observation, that, when there are much hectic and rapid disintegration 
of the pulmonary tissues, arsenic is not beneficial. Besides the stom- 
ach administration of arsenic in the above-mentioned maladies of the 
respiratory organs, it is used with advantage by the process of fumi- 
gation. The following is the formula of Trousseau for arsenical cigar- 
ettes : 

Arsenite of potassa 15 grains. 

Distilled water 1 ounce. 

Unsized white paper is thoroughly moistened with this solution, 
dried and cut into twenty equal parts, and each part rolled into a 



152 RESTORATIVE AGENTS. 

cigarette. Two or three of these are smoked daily for the relief of 
chronic bronchitis, emphysema, spasmodic asthma, phthisis, hay-asth- 
ma, etc. The arseniate of soda may be used in the same way, and 
under the same conditions ; for example, take a half -drachm to one 
drachm of arseniate of soda, one ounce of distilled water, and moisten 
a bit of unsized paper with the solution, so that every piece of a given 
size shall contain a determined quantity of the arsenic, ordinarily 
from one fourth to one grain. When the cigarette is lighted, the pa- 
tient inhales the smoke by a single inspiration, and this inhalation is 
practiced three or four times a day. In cases of acute and chronic 
coryza, great advantage is obtained by snuffing into the nares the 
fumes of arsenical cigarettes. The arsenite of antimony, according to 
Dr. Lucien Papillaud, is especially serviceable in pulmonary affections. 

When, in consequence of feebleness of the heart, there are present 
short breathing on making slight exertion, and oedema of the feet and 
ankles, especially as these symptoms occur in old people, arsenic is in- 
dicated. Attacks of angina pectoris may be lessened or prevented by 
the persistent use of arsenic in the interval. 

Certain disorders of the nervous system are greatly benefited by 
the use of arsenical preparations. The author has seen it extremely 
useful in cerebrcd congestion, for the treatment of which it was origi- 
nally recommended by Dr. Lemare-Picquot. It is indicated when there 
are commencing atheroma of the cerebral vessels, sluggish venous cir- 
culation, puffiness of the eyes, tendency to drowsiness, and intellectual 
torpor. In the melancholy and hypochondria of the aged, it gives great 
comfort, and frequently entirely dispels the gloomy fancies which take 
possession of the mind under these circumstances. The arsenic acts 
most favorably when combined with minute doses of opium ; viz., two 
drops of Fowler's solution, with three to five drops of tincture of opium, 
given three times a day. Arsenic is one of the remedies successful in 
the treatment of neuralgia. Generally its curative influence is indirect, 
and exerted through the improvement in the bodily nutrition which fol- 
lows its administration. It is directly curative, however, in the cases 
of hemicrania, and other neuralgim of malarial origin, but it holds a 
place strictly secondary to quinine in these affections. It is certainly 
one of the most effective remedies which we possess in the treatment 
of chorea. In this disease, large doses — five minims ter in die — must 
be given. Young subjects, it should be remembered, bear large doses 
of arsenic, relatively, better than adults. Cases of epilepsy have been 
reported cured by arsenic, but these were probably instances of epilepti- 
form vertigo caused by stomach-disorder, in which this remedy is un- 
doubtedly of great utility. Charcot has found the subcutaneous injec- 
tion of Fowler's solution of real value in paralysis agitans. The same 
expedient has succeeded in local chorea and histrionic spasm. The in- 
jection should be made into the affected muscles, whenever practicable. 



ARSENIC. 153 

Arsenic produces, in the course of its medicinal administration, affec- 
tions of the skin, and notably those dependent on an unknown state of 
the trophic nerves. In the treatment of various skin-affections we avail 
ourselves of this physiological fact, and set up by means of arsenical 
preparations a substitutive action in the skin. It follows, that arsenic 
will not be serviceable in acute affections of the skin, and experience 
demonstrates that, whenever active cell-proliferation is taking place, 
arsenic is contraindicated. It is most serviceable when the affection 
of the skin is superficial in its seat — in the epidermis and the superfi- 
cial layers of the derma. In cases of psoriasis much good may be ex- 
pected from it, but, the more chronic the disease, the more beneficial 
is it. When the arsenic begins to exert an influence on psoriasis, the 
skin appears more inflamed, but this is an evidence that the curative 
action is taking place, and the remedy should then be persisted in. 
Acute eczema is rather exasperated by arsenic, but chronic eczema, 
especially eczema squamosum, is often greatly benefited by it. When 
eczema infests the vulva, anal region, and scrotum, arsenic is said to be 
useful, but its efficacy in these cases is largely determined by the chro- 
nicity of the attacks. Pemphigus is an affection of the skin which, as 
was more particularly shown by Mr. Hutchison, is curable by arsenic, 
bat the more chronic the disease the more certainly beneficial the 
remedy. In old cases of acne, especially acne rosacea, arsenic is some- 
times serviceable, but it is often very disappointing. The author has 
not observed much good to follow the use of arsenic in the acne which 
occurs at puberty and for some years subsequently. In all cases of 
acne the strictest attention to diet and a proper hygiene is very im- 
portant. Arsenic given with bromide of potassium lessens or prevents 
the very disfiguring acne which appears in the course of the adminis- 
tration of that agent. Furuncle (boils) is successfully treated by the 
long-continued use of arsenic. This practice is strongly urged by 
Dr. Delioux de Savignac. A succession of boils is the indication for 
the use of this remedy. 

In the treatment of skin-affections, Fowler's solution is the arsenical 
preparation most frequently employed. The commencing dose need 
not be larger than five drops three times a day, given after meals. It 
is better to commence with the maximum dose, and to diminish the 
amount gradually. As arsenic needs to be administered for a long 
time in skin-diseases, such toxic symptoms as irritation of the eye- 
lids, puffiness of the eyes, and epigastric pain and soreness, are apt to 
arise. These symptoms are indications for the use of laxatives, and 
for a reduction in the dose of the remedy, but not for its entire sus- 
pension. In order to prevent relapses, the use of arsenic should be 
continued, in diminishing doses, for some time after the entire disap- 
pearance of the eruption. 

Arsenic is not serviceable in skin-diseases of syphilitic origin. In 



154 RESTORATIVE AGENTS. 

very chronic cases of this kind the compound solution of arsenic, 
iodine, and mercury — Donovan's solution — is sometimes very effective, 
but the curative effect is here due to the iodine and mercury, rather 
than to the arsenic. 

Arsenic is very useful in a certain form of chronic arthritis. The 
cases to which it is adapted are those in which the joints become tumid 
and stiff and painful in consequence of a peculiar state of the nervous 
system ; indeed, the condition is one allied to neuralgia, the trophic 
nerves being involved. This is a malady very different from that 
kind of chronic rheumatism or rheumatic gout which is accompanied 
by nodosities of the joints, in which arsenic has been recommended, 
but over which, according to the experience of the author, it exerts no 
control. 

Arsenic has seemed to the author remarkably beneficial in diabetes 
of hepatic origin. It has also been found useful by Johannsohn. 
Brunton reports good results from its administration in albuminuria, 
apparently due to defective digestion of albumen. 

Amenorrhoea, when due to functional inactivity of the ovaries, and 
menorrhagia, when produced by anaemia, are equally benefited by the 
preparations of arsenic, especially when combined with iron. /Sper- 
matorrhoea, if dependent on a weak and relaxed state of the seminal 
vesicles, and functional impotence, are sometimes greatly improved by 
full doses of the arseniate of iron. It is often advantageous to com- 
bine the arseniate of iron and ergotine, as follows : IjL Ferri arseniat., 
gr. v ; ext. ergotae, 3 ss. M. Ft. pil. no. xxx. Sig. : One night and 
morning. 

Next to quinine, arsenic has the most important position in the 
treatment of malarial fevers. It may be used to prevent the recur- 
rence of attacks of ague when quinine for any reason is not admissible. 
As regards acute malarial toxaemia, arsenic is more useful as an ad- 
junct to quinine than as the sole remedy. The treatment of acute cases 
may be formulated as follows : large doses of quinine to interrupt the 
paroxysms, and at the septenary periods ; arsenic given daily to pre- 
vent relapses. It plays a more important role in chronic malarial dis- 
eases. As has been shown by Boudin, arsenic diminishes the engorge- 
ment of the spleen. The author has witnessed the rapid disappearance 
of malarial jaundice, and the cure of the alterations in the glandular 
appendages of the intestinal mucous membrane, under its use. It is 
most useful generally to combine iron with arsenic in the chronic form 
of malarial disease. $ Mas. ferri carbon., 3 j ; acidi arseniosi, gr. j. 
M. Ft. pil. no. xx. Sig. : One three times a day. $ Quininse sulph., 
3ij ; ferri sulph. exsic, 3 j ; acidi arseniosi, gr. j. M. Ft. pil. no. xx. 
Sig. : One three times a day. Boudin justly insists upon abundant ali- 
mentation during a course of arsenical treatment of intermittents, and, 
with a view of preparing the digestive organs, administers a prelimi- 



ARSENIC. 155 

nary emetic to relieve the stomach of the embarras gastrique. Arsenic 
has also been used as & prophylactic against malarial infection, and as 
a remedy for various intermittent diseases due to malarial influence. 
The author has seen excellent results from the use of small doses of 
Fowler's solution three times a day in typho-malarial fever. When 
there is much diarrhoea, a few drops of tincture of opium should be 
added to each dose of arsenic. In doses of half a drop to one drop of 
Fowler's solution, the tongue cleans, the skin becomes moist, and the 
delirium lessens in a most remarkable manner, sometimes. When 
arsenic is used alone in the treatment of intermittents, large doses are 
necessary. Ten drops of Fowler's solution may be given after meals 
to adults, but in a few days — three, four, or five, according to the sus- 
ceptibility of the patient — the dose must be reduced two drops each 
day until four drops are reached. If the stomach does not become 
disordered, slight irritation of the conjunctivae and puffiness of the 
eyelids may be disregarded. 

There can be no doubt that the long-continued use of small doses 
of arsenic exercises a favorable influence over the course and progress 
of epithelioma. It has appeared, indeed, to be useful in scirrhus, es- 
pecially as this morbid process manifests itself in the stomach. Ro- 
dent ulcer, which is closely allied in its nature to epithelioma, is also 
improved by it. With the internal use of the arsenical preparations 
may be conjoined the local applications of arsenious acid. Many phy- 
sicians, notably Dr. Atlee, of Philadelphia, entertain the belief that 
the long-continued use of arsenic retards the growth of uterine cancer. 
It appears to the author to be certain that arsenic is useful in epithe- 
lioma, but he regards it as improbable that it exerts a curative influ- 
ence over the other forms of cancer, although it alleviates some of the 
distress experienced by the subjects of cancer of the stomach. Bill- 
roth reports a case of multiple lymphoma cured by the use of arsenic. 

External Uses of Arsenic. — An arsenical paste having the follow- 
ing composition is used to destroy the sensibility of a carious tooth : 
arsenious acid, ij ; sulphate of morphia, j ; sufficient creosote to make 
a paste. A small quantity of this is applied by a bit of cotton- wool 
to the carious portion of the tooth. 

Arsenious acid is sometimes employed to destroy cancerous 
growths. But, as it is extremely painful, and as the danger of ab- 
sorption is great, other escharotics, as, for example, the chloride of zinc, 
are generally preferred. When it is used, the operator should be 
careful to employ an arsenical paste of sufficient strength to set up a 
limiting inflammation, and thus prevent absorption. From one sixth 
to one fifth of arsenious acid is the proper proportion, and it may be 
mixed with calomel, starch, or other impalpable powder. If the sur- 
face to be destroyed is large, a portion of it should be submitted at a 
time to the action of the escharotic. Poultices should then be ap- 



156 RESTORATIVE AGENTS. 

plied until the slough separates, when a healthy granulating surface 
is obtained. The excessive pain caused by the escharotic may be 
much alleviated by combining morphine and carbolic acid in the ar- 
senical paste, or by the use of morphine hypodermatically until the 
escharotic action ceases. 

An arsenical paste prepared as follows is sometimes used as a de- 
pilatory : quicklime, § ss ; yellow sulphide of arsenic, grs. xx ; starch, 
3 ij. Sulphide of barium and oxide of zinc is a more efficient combi- 
nation. Esmarch's caustic is composed of : Arsenious acid, one part ; 
morphia sulph., one part ; calomel, eight parts ; and pulv. acaciae, 
forty-eight parts. Mix. Sprinkle thickly every day on a surface 
either raw or denuded of cuticle by a blister. 

In addition to the above local uses of arsenic, the results achieved 
by its hypodermatic injection should be mentioned. Dr. Radcliffe 
was the first to employ this practice in cases of local chorea of the head 
and neck, and in histrionic spasm. In these affections Fowler's solu- 
tion or Pearson's, in doses of two to ten minims, diluted with an equal 
measure of water, is thrown into the affected muscles daily, sometimes 
curing after some weeks of treatment. In obstinate cases of general 
chorea the subcutaneous injection of arsenic is now practiced, with 
good effects, a cure resulting more speedily than by the stomachal 
method of administration. Arsenic used by this method has proved 
to be the most effective remedy for lympadenoma. 

Authorities referred to : 

Gathgens, C. Zur Kenntniss der Arsenivirkungen. Centralblatt f. d. med. Wis., 32, 
1875, p. 529. 

Gies, Dr. Thomas. Experimentelle Untersuchungen uber den Einfuss des Arsons auf 
den Organismus. Archiv fur experimentelle Path, und Pharm., vol. viii, p. 176. 

Grohe, Fr., und Mosler, Fr., Profs. Zur Kenntniss der Veranderungen innerer Or- 
gane bei acuter Arsenvergiftung. Virchoufs Archiv, Band xxxiv, p. 208. 

Hebra, Prof. Dr. On Diseases of the Skin. Syd. Society edition, 1868. 

Hermann, Prof. Dr. Lehrbuch der experimentellen Toxicologic, Berlin, 1874, p. 224. 
Arsenverbindungen. 

Hoffman, Prof. Dr. Arsenikvergiftung und Cholera. Virchovfs Archiv, vol. 1, p. 455. 

Hdnt, Thomas, Mr. On the Treatment of Chronic Diseases of the Skin. The Lancet, 
vol. i, 1846. 

Isnard, M. Bulletin General de ITierapeutique, vol. lxxxiv, p. 80. Ibid., vol. lxxii. 

Johannsohn, Nicolai. Ueber die Einwirkung der arsenigen Saure auf Gdhrungsvor- 
gange. Archiv fur experiment. Pathol, und Pharmacol., vol. ii, p. 99. 

Kossel, Albrecht. Zur Kenntniss der Arsenwirkungen in Prof. Gathgens Labor, zu 
Eostock. Archiv f exper. Pathol, u. Pharm., vol. v, p. 128. 

Lesser, A. Archiv fur path. Anaiomie und Physiologie, 1873, p. 398, and 1874, 
p. 603. 

Lolliot, M. Bulletin General de Therapeutique, vol. lxxv, p. 338. 

Marme, W. Vergleichende Versuche uber die Wirkungen der arsenigen Saure und 
der Arsensaure. Abstract in Virchow und Hirsch, vol. i, 1876. 

Marsden, Dr. Alexander. A New and Successful Mode of treating Cancer, London, 
1869, p. 96. 



THE SIMPLE BITTERS. 157 

Ponteland Poisoning Cases. The Lancet, September 22, 1866, p. 337. 

Routh, Dr. C. H. F. Obstetrical Transactions, vol. viii, p. 290. 

Ringer and Murrell. Journal of Physiology, vol. i, p. 217. 

Scolosuboff, Dr. Sur la localisation de V arsenic dans les tissus d la mite de V usage 
des Arsenicaux. Archives de Physiol. Norm, et Path., vol. v, p. 563. 

Sklarek, Dr. W. Archiv fur Anat. und Physiologie, 1866, p. 41. TJie Physiological 
Effects of Arscnious Acid. 

Schafer, F., und Bohm. Ueber den Einfluss dcs Arsen auf die Wirkung ungeformtes 
Fermente. Virchow u. Hirsch, vol. i, 1872. 

Shulz, Dr. H. Weiterer Beitrag zur Theorie des Arsenwirkung. Archiv fur experi- 
ment. Pathologie u. Pharmacol,, vol. xiii, p. 256. 

Unterberger, S. Mitgetheilt von Prof. Bohm. Beitrdge zur Kenntniss der physiolo- 
gischen Wirkungen der Arsenigen Secure. Ibid., vol. ii, p. 89. 

Virchow, R. His Archiv, vol. xlvii, p. 524. Choleraahnlicher Befund bei Arsenik- 
vergiftung. 

THE SIMPLE BITTERS. 

Quassia. — Quassi amer, Fr. ; Quassienholz, Ger. The wood of 
Picrcena excelsa Lindley ( Quassia excelsa Swartz ; Nat. Ord. Simaru- 
bacece), IT. S. P. 

Preparations. — Extraction Quassice. Extract of quassia. Dose, 

g r - j— g r - "]• 

Tlnctura Quassice. — Tincture of quassia (10 parts to 100 of diluted 
alcohol). Dose, in, v — 3 j. 

Extractum Quassice Fluidum. — Fluid extract of quassia. Dose, 
tii v — 3 ss. 

Composition. — Quassia-wood contains a crystallizable bitter prin- 
ciple, neutral, called quassin. 

Gentiana.— Gentian, gentiane, Fr. ; Bitterwurzel, Ger. The root 
of Gentiana lutea Linne (Nat. Ord. Gentianacece), XL S. P. 

Preparations. — Infusum Gentiance Compositum. (Not official.) 
Compound infusion of gentian. (Gentian, bitter orange-peel, corian- 
der.) Dose, 3 j — S j. 

Tinctura Gentiance Composita. — Compound tincture of gentian. 
(Gentian, bitter orange-peel, cardamom, alcohol.) Dose, 3 ss — 3 ij. 

Extractum Gentiance Fluidum. — Fluid extract of gentian. Dose, 
3 ss— 3 ij. 

Extractum Gentiance. — Extract of gentian. Dose, gr. j — gr. v. 

Composition. — Gentian contains a peculiar principle, gentianine, 
and an acid, gentisic acid. 

Gentiana Catesbsei. — Blue gentian, American gentian. This in- 
digenous remedy may be used as a substitute for the foreign gentian, 
and similar preparations to the official formula for gentian, as above, 
may be prepared from it. 

Unofficial Formulae. — Mistura gentiance atkalina. Dilute hy- 
drocyanic acid, Tit iij ; bicarbonate of soda, grs. xv ; compound infu- 
sion of gentian to oz. j. 

Mistura Gentiance et Sennce. — Infusion of gentian, drachms vj ; 



158 RESTORATIVE AGENTS. 

infusion of senna, drachms iij ; compound tincture of cardamoms, 
drachm j. 

Calumba. — Colombe (ratine de), Fr. ; Ruhmcurzel, Ger. The root 
of Jdteorrhiza calumba Meiers (Nat. Ord. Menispermacew). 

Peepaeations. — Infusum Calumbos. (Not official.) Infusion of 
calumba ( f j — Oj). Dose, § ss — 3 ij. 

Tinctura Calumbce. — Tincture of calumba (10 parts to 100 of di- 
luted alcohol). Dose, 3 ss — 3 ij. 

Extr actum Calumbos Fluidum. — Fluid extract of calumba. Dose, 
3 ss— 3 ij. 

Composition. — A peculiar principle, colombin, berberine, and a 
peculiar acid, colombic acid. 

Coptis. — Goldthread. The root of Coptis trifolia. There are no 
official preparations of coptis. It contains, in common with some 
other bitters, the alkaloid berberine, and probably also a peculiar bit- 
ter principle. It yields up its alkaloids and bitter principle to both 
water and alcohol, but more freely to the latter. The tincture and 
fluid extracts are, therefore, the best preparations. 

Sabbatia. — American centaury. Herb of Sabbatia annularis. As 
there are no official preparations of sabbatia, a tincture and fluid ex- 
tract made in accordance with the general instructions given in the 
United States Pharmacopoeia may be used. 

Cornus. — Dogwood. The bark of the root of Cornus Florida Linne 
(Nat. Ord. Cornaceai). 

Peepaeation. — Extractum Cornus Fluidum. — Fluid extract of 
dogwood. Dose, tti x — 3 j. 

Decoctum Cornus Floridce. — (Not official.) Decoction of dogwood 
(Ij— °j)- Dose, 1 ss — § ij. 

Antagonists and Incompatibles. — Quassia and calumba can be 
administered with the salts of iron. The sulphate of iron, and the sil- 
ver and lead salts, are incompatible with gentian. The infusion of 
coptis is not affected by the salts of iron, but is precipitated by the 
nitrate of silver and acetate of lead. Therapeutically, all those agents 
which promote waste or destructive metamorphosis are opposed to the 
action of the simple bitters. 

Stneegists. — Iron, the mineral acids, pepsin, bismuth, etc., are 
synergistic to the bitters, and under some circumstances the alkalies 
promote their therapeutic action. 

Physiological Actions. — The simple bitters increase secretion 
from the mucous membrane. In the mouth they promote the flow of 
saliva, and in the stomach they appear to stimulate the production 
of gastric juice, and also of gastric mucus. It follows that an increase 
of digestive capacity is one result of their administration. The in- 
creased appetite which is observed from the use of the bitters is prob- 
ably due to two factors : the sense of bitterness which increases the 



THE SIMPLE BITTERS. 159 

desire for food, and the improved digestive power which, enabling 
more food to be disposed of, postpones the sense of satiety. Further- 
more, the bitters, by removing morbid states of the intestinal mucous 
membrane, favor assimilation. More food being taken and more 
thoroughly digested, it is obvious that the bitters promote construc- 
tive metamorphosis. The blood is indirectly enriched by them, and 
the tissues are consequently improved in their nutrition. The simple 
bitters are accordingly usually classed with tonics. 

To these effects of the simple bitters as a group, it is necessary to 
add that the active constituents of some of them have been studied in 
detail. Berberine, which enters into the constitution of several, is 
possessed of some antiseptic and antiperiodic power, but is not active 
from the physiological point of view. Quassin has recently been 
studied by Dr. Campardou, and his observations published in a special 
memoir. There are, however, no new facts produced. Quassin, as 
might be supposed from its origin, acts after the manner of the bitter 
tonics ; it increases the appetite, and promotes the digestive functions 
by stimulating the secretions of the gastro-intestinal mucous mem- 
brane, and the contractility of the muscular fiber of the intestine. In 
an overdose quassine causes the local and systemic symptoms of an 
irritant poison. 

Although these remedies, used judiciously and for a short period, 
undoubtedly promote the constructive metamorphosis, yet their long- 
continued use will produce gastric catarrh, decrease the flow of healthy 
gastric juice, and impair digestion. 

Thekapy. — An infusion of coptis has much reputation in Xew 
England as a remedy in aphthae, psoriasis of the mucous membrane, 
ulcers, and epithelioma. Used as a gargle, it is serviceable in ulcera- 
tion of the tonsils. 

A few drops of the tincture of calumba, or a teaspoonful of the in- 
fusion, will sometimes greatly relieve the vomiting of pregnancy, and 
is also occasionally efficacious in sea-sickness. The simple bitters are 
especially indicated in atonic dyspepsia, and in chronic gastric catarrh. 
They are useful in this state of things : pain after food, slow diges- 
tion, constipation alternating with diarrhoea. Calumba is the mildest, 
and may be borne when quassia and gentian disagree. According to 
Wilson Fox, " calumba holds the chief place in point of therapeutic 
value as a remedy which can be safely employed when others of the 
class would be too irritating." When there are much relaxation and 
torpor, quassia is very useful as a stomachic tonic. Sometimes an ex- 
temporaneous cold infusion of quassia is used, made by filling over- 
night with cold water a quassia-cup — a goblet turned out of quassia- 
wood. When constipation exists in cases of atonic dyspepsia, good 
results are obtained by a combination of gentian with senna, as in the 
formula already given. The compound tincture of gentian is an ex- 



160 RESTORATIVE AGENTS. 

cellent vehicle for the administration of cod-liver oil, and contributes 
to its digestion and assimilation. 

The infusions of gentian, calumba, and quassia are usefully em- 
ployed as vehicles for the administration of acids and alkalies in cases 
of acidity and deficient supply of gastric juice, under the rules given 
in the articles on acids and alkalies. 

In convalescence from acute diseases, the simple bitters, especially 
gentian and calumba, are employed to promote the appetite and diges- 
tion, and thus to aid in the process of constructive metamorphosis. 

In the diarrhoea which is due to relaxation of the mucous mem- 
brane, and is not dependent on inflammation, the tincture of calumba 
is often useful. The author has obtained good results from the use 
of tincture of calumba combined with opium in the treatment of an 
irritable state of the intestinal mucous membrane, indicated by these 
symptoms : Soon after taking food, the occurrence of pain referable 
to the small intestines, nausea, loose evacuations containing undigest- 
ed aliments, and followed by weakness and depression. ^ Tinct. ca- 
lumbae, 3 xv ; tinct. opii deodor., 3 j. M. Sig.: A teaspoonful in a 
wineglassful of water before meals. Calumba is also serviceable in 
the relaxation of the bowels succeeding to acute affections of the in- 
testinal mucous membrane. 

The infusion of quassia is one of the most effective injections for 
the destruction of the ascarides vermiculares which infest the rectum. 
The stomach administration of simple bitters undoubtedly hinders the 
development of intestinal worms, probably by correcting a morbid 
state of the mucous membrane. In the treatment of intestinal para- 
sites much good, therefore, is derived from the use of bitters, admin- 
istered with the view of restoring normal digestion. 

According to Wood, the remedy most effective to remove and 
" permanently cure a disposition to the accumulation of flatus in the 
bowels is an infusion made with half an ounce of calumba, half an 
ounce of ginger, a drachm of senna, and a pint of boiling water, and 
given in the dose of a wineglassful three times a day." 

The bitters are used as remedies in malarial fever. Although they 
exercise but little influence over the course of intermittent and remit- 
tent fever, they are useful in the form of infusion as vehicles for the 
administration of more active drugs. In the convalescence from mala- 
rial fever, and in chronic malarial poisoning, they are more actively 
beneficial as agents promoting constructive metamorphosis. The dog- 
wood, of all the bitters given in the above list, possesses the most 
positive antiperiodic qualities, and is considered by the physicians of 
Southern United States as next to quinine in efficiency. An excellent 
tonic combination of decided utility in chronic malarial disease is the 
following : Dogwood-bark, calumba, poplar (liriodendron), wild-cherry, 
of each six ounces ; boneset (eupatorium) and cayenne pepper, of each 



AROMATIC BITTERS. 161 

four ounces. Mixed and sifted. Of the mixture a teaspoonful in 
cold or warm water, three or four times a day. A useful tincture to 
serve the purpose of a tonic, and as a remedy in malarial affections, 
may be prepared from the above combination of bitter tonics. 

AROMATIC BITTERS. 

Serpentaria. — Virginia snakeroot. Serpentaire de Virginie, Fr. ; 
Schlangenwurzel, Ger. The rhizoma and rootlets of Aristolochia ser- 
pentaria and of Aristolochia reticulata Nuttall (Nat. Ord. Aristolo- 
chia}), U. S. P. 

Preparations. — Infusum Serpentaria}. — Infusion of serpentaria 
( f ss — Oj). Dose, 1 ss — § j. (Not official.) 

Tinctura Serpentaria^. — Tincture of serpentaria ( § iv — Oij). Dose, 
3 ss— 3 ij. 

Extractum Serpentaria} Fluidum. — Fluid extract of serpentaria. 
Dose, 3 ss — 3 ij. 

Composition. — A volatile oil, resin, a bitter principle, etc. 

Primus Virginiaiia. — Wild cherry. The bark of Prunus serotina. 

Preparations. — Infusum Pruni Virginians. — Infusion of wild- 
cherry ( 5 ss — Oj). Dose, | ss — f ij. 

Extractum Pruni Virginians Fluidum. — Fluid extract of wild- 
cherry bark. Dose, 3 ss— 3 j. 

Syrupus Pruni Virginians. — Sirup of wild-cherry. Dose, 3 j — 

3 ij. 

Composition. — Amygdalin and emulsin, which produce by their 
reaction hydrocyanic acid, tannic and gallic acids, etc. 

Cascarilla. — Cascarilla. Cascarille, Fr. ; Cascarille Pinde, Ger. 
The bark of Croton Eleutheria Bennett (Nat. Ord. Euphorbiaces) . 

Preparations. — Infusum Cascarilla}. (Not official.) Infusion of 
cascarilla ( § j — Oj). Dose, f ss — § j. 

Composition. — A crystallizable principle, cascarillin, tannic acid, 
a volatile oil, etc. 

Actions and Uses. — These remedies possess the quality called tonic ; 
they invigorate digestion, and promote constructive metamorphosis. 
They differ from the simple bitters in containing aromatic constituents, 
and in being astringent to a greater or less degree, owing to the pres- 
ence of tannic and gallic acids. They are indicated in the same kind 
of cases as, and under similar conditions to, the simple bitters ; but 
they are supposed to have, in addition, some specific properties derived 
from their volatile and odorous constituents. 

Serpentaria is occasionally used as a stimulating tonic in typhoid 
and typho-malarial fevers. It is more frequently prescribed as a 
stimulant expectorant in capillary bronchitis, and in pneumonia of 
low grade, when carbonate of ammonia is combined with it. For- 
merly it was used locally to the throat, as a gargle in diphtheria, and 
11 



162 RESTORATIVE AGENTS. 

given internally as a stimulant, but it is now very rarely employed in 
such cases. 

Wild-cherry is an excellent stomachic tonic, and may well be used 
as a substitute for calumba in the class of cases to which the latter is 
considered specially applicable. It has long been held in great esteem 
in domestic practice, as a remedy in catarrhal states of the bronchial 
mucous membrane, and in phthisis. Owing to the prussic acid which 
its cold infusion contains — produced by the reaction between the amyg- 
dalin and emulsin — it exercises some influence over cough. That it 
has any special virtues in the treatment of phthisis is hardly to be 
credited. The sirup is much used as an ingredient in cough-mixtures. 

Authorities referred to : 

Porcher, Dr. Francis Peyre. Resources of the Southern Fields and Forests, Charles- 
ton, 1869. 

Huseman, Drs. August und Theodor. Die PJlanzenstoffe. 
Fox, Dr. Wilson. The Diseases of the Stomach, 1872. 

Eucalyptus. — Leaves of Eucalyptus globulus Labillardiere (Nat. 
Ord. Myrtacece). U. S. P. 

Preparations. — Tinctura Eucalypti. (Not official.) Tincture of 
eucalyptus. Dose, 3 ss — 3 ij. 

Extractum Eucalypti Fluidum. — Fluid extract of eucalyptus. 
Dose, in, x — 3 j. 

Eucalyptol. — Dose, in v — 3 ss. Usually prescribed in capsules, but 
may be given in the form of emulsion. 

Composition. — Eucalyptus contains a peculiar resin composed of 
three different resinous bodies, a volatile oil consisting of eucalyptol, 
turpene, and cymol, tannic acid, and a crystallizable fatty acid. Euca- 
lyptol is the most important of the constituents. 

Antagonists and Incompatibles. — Alkalies, the mineral acids, 
the salts of iron, mercury, lead, zinc, etc., are chemically incompatible. 
All agents promoting waste, or the retrograde metamorphosis of tissue, 
are therapeutically incompatible. 

Synergists. — The simple and aromatic bitters, hydrastis, cinchona, 
etc., camphor, turpentine, cubebs, copaiba, the essential oils and sub- 
stances containing them, are synergistic to or promote the therapeuti- 
cal actions of eucalyptus. Any of these remedies may, therefore, be 
prescribed in the same formula with eucalyptus. 

Physiological Actions. — Eucalyptus has a warm, aromatic, bitter, 
and camphoraceous taste, resembling somewhat the taste of cubebs. 
In the mouth it excites the flow of saliva, and leaves a hot, pungent, 
and rather disagreeable flavor. In the stomach it causes a sensation 
of warmth, and doubtless promotes the flow of gastric juice. The 
appetite and digestive power are increased under its use. Increased 
intestinal secretion, also, is one result of its administration, and hence 



EUCALYPTUS. 163 

the alvine evacuations are rendered somewhat more copious and easy. 
In very large doses it causes a sense of weight and uneasiness at the 
epigastrium, odorous eructations and indigestion, followed by diarrhoea, 
the stools having the characteristic odor of eucalyptol. The essential 
oil is readily diffusible and enters the blood with facility, but what 
changes, if any, it induces in the blood are unknown. It increases the 
action of the heart, lowers the arterial tension, and induces a feverish 
state. The respiratory movements are accelerated. Wakefulness is 
caused by it in those of full health, and sleep in the weak and anaemic. 
The eucalyptol is eliminated by the skin, mucous membrane of the 
bronchial tubes, and by the kidneys, the secretions of these organs 
being increased by it, and they are impregnated with its odor. This 
is especially the case with the urine, which, after some days' adminis- 
tration, becomes most strongly odorous by the presence of eucalyptol. 

The vapor of eucalyptus, inhaled in large quantity, produces analo- 
gous effects to the internal administration, besides the more decided 
effects on the bronchial mucous membrane. 

Eucalyptus is a powerful diaphoretic. 

Therapy. — The decoction of the leaves is an efficient local appli- 
cation in the various forms of stomatitis, angina subacute and chronic, 
and tonsillitis after the subsidence of the acute stage. 

Eucalyptus is one of the most useful of the so-called stomachics in 
atonic dyspepsia, chronic gastric catarrh, and chronic intestinal ca- 
tarrh, but its use is contraindicated in inflammatory states. The form 
of vomiting and indigestion dependent on the presence of sarcina is 
relieved by this agent, which acts by destroying the vitality of this 
minute organism. That condition of the mucous membrane which 
favors the production of intestinal parasites is removed by eucalyptus. 
In the case of ascarides vermicular 'es, the remedy should be used by 
injection. 

Like the bitters, eucalyptus may be used to promote constructive 
metamorphosis, but it possesses more decided stimulant effects than 
these agents, by virtue of the eucalyptol. In convalescence from acute 
disease, in debility arising from defective assimilation, and in cachectic 
states generally, it is a serviceable tonic and stimulant. When the ac- 
tion of the heart is weak, it may be strengthened by eucalyptus. To 
women at the change of life who suffer from flatulence, palpitation of 
the heart, and sudden flushings of the face, it affords great relief, and 
often permanently removes these symptoms. 

Hysteria, chorea, asthma, and allied nervous states, when occurring 
in debilitated subjects, and cerebral ancemia, are benefited by eucalyp- 
tus. In asthma eucalyptus may be smoked in cigarettes with stramo- 
nium, belladonna, tobacco, etc. Its efficacy in the form of fumes is 
strongly stated by Maclean. 

The most important uses of this agent occur in the treatment of 



164 RESTORATIVE AGENTS. 

catarrhal affections of the broncho-pulmonary mucous membrane. It 
is not adapted to acute affections or to recent inflammation, but to 
chronic cases accompanied by free muco-purulent expectoration. The 
author is able to confirm the observations of Gubler in reference to the 
great utility of eucalyptus in bronchorrhcea. It is an interesting fact, 
and probably explanatory of its therapeutical action, that eucalyptol is 
in part eliminated by the bronchial mucous membranes. In the same 
way eucalyptus is effective in the treatment of catarrhal states of the 
genito-urinary organs. Chronic desquamative nephritis, granular de- 
generation of the kidneys, pyelonephritis, and hydronephrosis, are im- 
proved by its cautious administration, but it should not be forgotten 
that, used too freely, or for too great a length of time, it will cause 
irritation and congestion of the kidneys, in the same way that turpen- 
tine, copaiba, and cubebs do. 

No remedy which the author has hitherto used has seemed to him 
so effective in chronic catarrh of the bladder as eucalyptus. The urine 
during its administration acquires a strong odor of eucalyptol, and to 
its local action on the mucous membrane is to be attributed the thera- 
peutical effect. 

Eucalyptus has been much praised as a remedy for intermittent 
fever. The evidence as to its utility is contradictory. As the result 
of his own observations, and after careful examination of the facts 
reported by others, the author concludes that eucalyptus is far inferior 
to quinine. It is certainly very serviceable in the convalescence from 
intermittent and remittent fevers, and in chronic malarial poisoning it 
has a high degree of utility. It can not take the place of quinine for 
the arrest of the paroxysms, or to prevent relapses at the septenary 
periods, but it is more useful than quinine to reconstruct the damages 
in the organs of assimilation caused by malarial infection. 

Externally, the tincture and the distilled water of eucalyptus are 
used as disinfectant applications to foul-smelling and ill-conditioned 
ulcers and wounds (Gimbert). The water of eucalyptus is recom- 
mended by Gubler as a vehicle for agents used by the hypodermatic 
method. The toxic influence of eucalyptus on the lower forms of life 
— cryptogamic and infusorial organisms — is the ground of its applica- 
tion for these purposes. As respects solutions of alkaloids for hypo- 
dermatic use, the water of eucalyptus prevents the development of the 
penicillium, which grows rapidly and at the expense of the alkaloid 
in solutions prepared with simple distilled water. 

Authorities referred to : 

Burdel, Dr. E. Bulletin de Therapeutique, tome lxxxiv, p. 409, et ibid., tome lxxxv, 
p. 529. 

Costau, M. Gazette Hebdomadaire, 1872, No. 25. Bidletin de Therapeutique, tome 
lxxxiii, p. 237. 

Gimbert, M. xe Db. ^Bulletin de Tlierapeutique, tome lxxxii, p. 422. 



HYDRASTIS. 165 

Gubler, Dr. A. Bulletin de Therapeutique, tome lxxxi, pp. 145, 193. 

Keller, Dr. The British Medical Journal, May 11, 1872. 

Lorinser, Dr. Wiener medicinische Wochenschrift, 1869, xix, 43. 

Maclean, Dr. M. C. The Practitioner, vol. vii, p. 268. 

Schmidt's Jahrbucher der gesammten Medicin,vo\. cxlviii, p. 11. Ueber Eucalyptus 
Globulus ; nach F. W. Lorinser ; C. Haller ; Franz Seitz ; L. A. Buchner ; C. Paul ; 
A. Gubler. 

Ibid. Vol. cl, p. 121. Ueber den Nutzen des Eucalyptus gegen WecJiselJieber. 

Hydrastis. — The Moot of Hydrastis Canadensis. Yellow-root. 

Preparations. — Extractum Hydrastis Fluidum. Fluid extract 
of Hydrastis. Dose, v\ v — f ss. 

Tinctura Hydrastis. — Tincture of Hydrastis. Dose, tti x — 3 j. 

Composition. — Hydrastis contains a peculiar principle, hydrastine 
or hydrastina, which crystallizes in four-sided prisms, white or color- 
less when pure, and having but little taste. Hydrastine, the alkaloid, 
should not be confounded with the eclectic preparation, hydrastin, 
which is composed chiefly of berberine. Much of the peculiar virtues 
of hydrastis is probably due to the alkaloid berberine, which is con- 
tained in it in the proportion of about four per centum. Both of these 
alkaloids unite with acids to form salts. 

Antagonists and Incompatibles. — The alkalies, tannic and muri- 
atic acids, are chemically incompatible with the preparations of hy- 
drastis. Muriatic acid precipitates berberine, and the so-called hy- 
drastine of the eclectic practitioners is nothing more than berberine 
muriate. In prescribing the tincture and fluid extract of hydrastis 
with other bitters, only those free from tannin should be combined in 
the same prescription. 

Synergists. — The vegetable tonics in general are synergistic to 
hydrastis, especially berberis vulgaris and calumba, both of which con- 
tain berberine. 

Physiological Actions. — The preparations of hydrastis have a 
decidedly bitter taste, and, like other bitters, promote the flow of saliva, 
and probably, also, of gastric juice. Increased appetite and digestive 
power result from its administration. It is, therefore, a stomachic 
tonic. It also increases secretion of the intestinal mucous membrane 
— its glandular appendages — and, there are good reasons for believing, 
promotes the flow of bile. As a result of this increase of secretion, 
the stools become softer and more frequent under its use, and it has 
hence been styled a laxative. The bodily condition, or constructive 
metamorphosis, is promoted by its administration. On the nervous 
system, hydrastis, especially the alkaloid hydrastine, has effects some- 
what like, but less than, those of quinine ; but it appears to be devoid 
of toxic power. 

Therapy. — Stomatitis, both mercurial and aphthous, is much im- 
proved by local application of the fluid extract of hydrastis. When 



166 RESTORATIVE AGENTS. 

this preparation causes much smarting, it may be diluted with water. 
Follicular pharyngitis, chronic coryza, and even syphilitic affections 
of the mouth, throat, and nares, may be much benefited or even cured 
by the same application. It is said that five to ten drops of the 
fluid extract, taken by the stomach, will act favorably in the removal 
of the very troublesome affections named above, but the author is un- 
able to verify these observations. 

Hydrastis is very useful as a stomachic tonic, and may take the 
place of calumba in the treatment of atonic dyspepsia. A few drops 
of the tincture or fluid extract (five to fifteen) taken before meals, 
daily, for some time, will often cure chronic gastric catarrh, and remove 
the distressing headache which frequently accompanies this disease. 
It is one of the best remedies for the stomach catarrh of chronic alco- 
holism, and is probably the best substitute, if given in sufficient doses, 
for the alcoholic stimulant when its habitual use is to be abandoned. 
Catarrh of the duodenum is in a similar manner relieved by hydras- 
tis, but this agent has special utility in duodenal catarrh when accom- 
panied by catarrh of the gall-ducts and jaundice. Its use should, in 
these affections, be continued for some time. When a catarrhal state 
of the cystic duct — often resulting from or aggravated by catarrh of 
the duodenum — leads to inspissation of the bile and crystallization of 
the cholesterin, decided benefit accrues from the use of the prepara- 
tions of hydrastis. 

When constipation is dependent on deficient secretion, and the 
stools are dry and hard, it may be overcome by this remedy, but tor- 
por of the muscular layer of the intestine is not affected by it. 

Chronic catarrh of the intestine, even when it has proceeded to 
ulceration, is sometimes remarkably benefited by hydrastis. When 
the stools are very frequent and there is much pain, it is advantageous 
to combine a little opium with it. In fissure of the anus, haemorrhage 
from the rectum, and ulceration of the rectal mucous membrane, appli- 
cations of fluid extract of hydrastis to the affected parts promote heal- 
ing. 

The alkaloid hydrastine may be used as a substitute for quinine in 
many of the conditions for which the latter is now so frequently pre- 
scribed, viz., to promote appetite and digestion, and to improve assimi- 
lation in cases of debility, in convalescence from acute diseases, in the 
various cachexia?, especially the paludal. 

As a remedy for inter mittents, hydrastine ranks below quinine 
considerably. It should be given under the same regulations as those 
which govern the administration of quinine, to the physiological and 
therapeutical action of which it is closely allied. The hydrastine of 
the eclectics, which is really muriate of berberine, is also a remedy of 
value in intermittents. The fluid extract of hydrastis contains, of 
course, both alkaloids. In chronic malarial poisoning (paludal ca- 



CINCHONA. 167 

chexia), hydrastine and berberine may be given with ferruginous prep- 
arations, as quinine is so frequently employed. It exerts the same 
power, though less in degree, which quinine has over enlarged spleen 
of malarial origin. 

The preparations of hydrastis are used with advantage in certain 
affections of the genito-urinary organs. In chronic JBrighfs disease, 
it appears to lessen the excretion of albumen. It diminishes the mu- 
cus in catarrh of the bladder. It is often the most efficacious remedy 
which we can employ in gonorrhoea after the acute stage has subsided, 
and in gleet. Especially in the latter has the author witnessed ex- 
cellent results from its employment. The local use of hydrastine, or 
of the fluid extract of hydrastis, should be conjoined with the internal 
administration. The author has seen no injection so frequently suc- 
cessful in gonorrhoea as hydrastine. $ Hydrastinse, 3 j ; mucil. aca- 
ciae, § iv. M. A half-ounce as an injection. Better, probably, the 
fluid extract, diluted properly or in combination, may be used for the 
same purpose. It is also a useful medicine in the treatment of sper- 
matorrhoea, prostorrhoea, or urethral leucorrhoea, when locally applied. 

Uterine and vaginal leucorrhoea, ulcerations, and erosions of the 
cervix uteri, are quickly improved by the topical application of the 
fluid extract of hydrastis, which may be used in an undiluted state. 

Unhealthy and sloughing sores, chancroid, old ulcers of the leg, 
are improved in character by the local use of this remedy. To pre- 
vent septic decompositions in wounds or cavities communicating with 
the external air, it may be freely used by local application and injec- 
tion. It has also been used, apparently with benefit, to the surface of 
cancerous growths ; but the only influence it can have in this disease 
is to relieve fetor by preventing decomposition. 

Authorities referred to : 

Porcher, Dr. F. Peyre. Resources of the Southern Fields and Forests, Charleston, 
1869, p. 15. 

CINCHONA AND ITS PREPARATIONS. 

Cinchona. — Cinchona. The bark of any species of Cinchona (Ru- 
biaceae) containing at least three per cent of its peculiar alkaloids. 
(U. S. P.) 

Cinchona Flava. — Yellow cinchona (calisaya-bark). The bark of 
Cinchona calisaya. It should contain not less than two per cent of 
alkaloids which yield crystallizable salts. 

Cinchona Rubra. — Red cinchona. The bark of Cinchona succi- 
rubra. It should contain not less than two per cent of alkaloids 
which yield crystallizable salts. 

Preparations. — Decoctum Cinchonas Ftavm. Decoction of yellow 
cinchona ( f j — Oj). Dose, § ss — 1 j or more. 

Infusum Cinchonm. — Infusion of cinchoua (cinchona, yellow bark, 



168 RESTORATIVE AGENTS. 

unless specified, 6 parts ; aromatic sulphuric acid, 1 part ; water to make 
up 100 parts). Dose, 3 j — 1 j or more. 

Extractum Cinchona. — Extract of cinchona (cin. flava). Dose, 

g r - j— x - 

Extractum Cinchonce Fluidum. — Fluid extract of cinchona. Dose, 
hi x — 3 j or more. 

Tinctura Cinchonce. — Tincture of cinchona (yellow cinchona, 20 
parts to 100 of alcohol, glycerin, and water). Dose, 3 ss — 3 ij. 

Tinctura Cinchonce Composita. — Compound tincture of cinchona 
(red cinchona, 10 parts ; bitter orange-peel, 8 parts ; serpentaria, 2 
parts ; alcohol, glycerin, and water, to make 100 parts). Dose, 3 j — 
?ss. 

Cinchonince Sulphas. — Sulphate of cinchonine ; occurs in white, 
shining crystals ; dissolves in fifty-four parts of cold water, in much 
less boiling water, in seven parts of alcohol, and very sparingly in 
ether. Dose, gr. v — 3 ss. 

Quinince Sulphas. — Sulphate of quinine ; occurs in colorless, very 
light, and silky crystals ; is entirely dissolved by about seven hundred 
and forty parts of cold, or thirty of boiling water, is readily soluble in 
alcohol, and in water acidulated with sulphuric acid, but is insoluble 
in ether. Dose, gr. j — 3]. 

Quinince Valerianas. — Valerianate of quinine. A colorless salt, 
crystallizable, and having a peculiar odor and bitter taste ; is soluble 
in one hundred and ten parts of cold, or in forty parts of boiling water, 
and in six parts of cold alcohol. Dose, gr. j — 3j. 

Pilulce Quinince Sulphatis. — Pills of sulphate of quinine. Each pill 
contains one grain. 

Unofficial Salts of Quinine, — Kinate, tannate, citrate, acetate, tar- 
trate, phosphate, nitrate, hydrochlorate, arseniate, f errocyanate, picrate, 
etc. Salicylate of cinchonidine is a really useful addition to these 
salts. It has therapeutic property only second to the salts of quinine, 
and may be substituted for the latter in the treatment of malarial 
affections. 

Composition. — Cinchona is remarkable for the number and variety 
of the principles obtained from it, viz., five alkaloids, two simple acids, 
two tannic acids, and a resinoid substance. The most important alka- 
loid is quinine, which exists in all varieties of bark, but is most abun- 
dant in the yellow or calisaya bark. It occurs in combination with 
kinic and kino-tannic acids. Quinidine is an alkaloid isomeric with 
quinine, and may be used as a substitute for the latter in the same 
dose. It is less bitter than quinine, and its sulphate is more soluble in 
water. Cinchonine is found in greatest quantity in the pale barks. 
It unites with acids to form salts, of which the sulphate is most fre- 
quently used. Therapeutically considered, cinchonine has about half 
the strength of quinine. Cinchonidine is an alkaloid isomeric with 



CINCHONA. 169 

cinchonine as quinidine is with quinine. Aricine, which has close anal- 
ogies with cinchonine, has been found in the aricia or Cusco bark. 

The alkaloids are combined in bark with the acids kinic and Jcino- 
vic, chiefly with the former. There are also two kinds of tannic acid, 
kino-tannic and Jcinovi-tannic, and a resinoid substance, kinovin. 
None of these have thus far been applied to therapeutical purposes, 
except kinic acid, which has been utilized to form a kinate of quinine, 
under the belief that a combination of quinine in its natural state 
would be more efficient as a remedy than as combined with a mineral 
acid. 

When the mother-liquor, left after the crystallization of the alka- 
loids, is evaporated, a black residue is obtained, which is called chinoi- 
dine. This contains amorphous quinine and cinchonine, and probably 
also quinidine and cinchonidine. It is a very efficient anti-periodic, 
and may be used with advantage as a substitute for quinine, in doses 
about twice as large. 

With regard to the quantity of the alkaloids contained in the barks, 
respectively, it may be stated that the three varieties — pale, yellow, 
and red — differ only in the relative proportions of their constituents. 
The pale bark contains most cinchonine, the yellow most quinine, and 
the red an equal proportion of each. 

Administration. — The alkaloids of bark are intensely bitter. 
Quinine being insoluble in the saliva, is less objectionable than its 
salts. The sweet principle of liquorice covers the taste of the cin- 
chona alkaloids. A sufficient dose of quinine may easily be inclosed in 
a chocolate caramel. The sugar-coated pill, when freshly prepared 
and by a reputable maker, is a convenient and suitable form for ad- 
ministration ; but by keeping it becomes hard and insoluble. The 
most active form is a solution, the quinine being dissolved by the 
aid of sufficient dilute acid. For hypodermatic use, the following 
formula may be followed : $ Quininae sulphat., 3 j ; morphinae 
sulph., gr. ss ; acid, sulphur, dil., n\, xl ; aquae destil., § j. M. Fil- 
ter. Sig. : Sixty minims contain seven and a half grains. Lente's 
solution is the following : 3 Quininae bisulph., grs. 1 ; acid, sulph. 
dil., TTJ, c ; aquae font., § j ; acid, carbol. liq., m, v. Solve. The qui- 
nine is dissolved by the aid of heat, and after filtration the carbolic 
acid is added. 

Antagonists and Incompatibles. — Substances containing tannic 
acid in a free state should not be administered with the infusum or 
decoctum cinchonas. The preparations of iodine (tincture and com- 
pound solution) are also incompatible, for they form insoluble com- 
pounds with the cinchona alkaloids. The alkalies, alkaline carbonates, 
and alkaline earths, should not be administered with the solutions of 
the alkaloids, because the latter will be precipitated. 

As an agent promoting constructive metamorphosis, cinchona and 



170 RESTORATIVE AGENTS. 

its alkaloids are therapeutically antagonized by mercury, the iodides, 
the salts of copper, zinc, and lead. 

As Gubler has shown, morphine and quinine are antagonists in re- 
spect to their effects on the brain. As regards their action on the 
sympathetic system, on the heart, and on the temperature, quinine, and 
belladonna and its alkaloid, are antagonistic. 

Synergists. — All those agents which promote constructive meta- 
morphosis, as the bitters, the ferruginous preparations, arsenic, and 
the acids, are synergistic to cinchona. 

Physiological Actions. — The preparations of cinchona are known 
as " astringent bitters " : they contain, in addition to bitter principles, 
two tannic acids. As bitters they act as stomachic tonics ; that is, 
promote appetite, the flow of gastric juice, and the digestive power. 
Long continued, as is the case with all the other bitters, they set up a 
gastric catarrh, and digestion becomes painful and labored. They 
differ from the simple bitters in exercising an astringent action on the 
intestinal mucous membrane, and cause constipation. The red bark 
is more decidedly astringent than the yellow or pale bark. 

Since the time of Sir John Pringle, who made the first experiments 
on this point, cinchona has been known to possess antiseptic properties. 
The powdered bark, applied to unhealthy wounds, arrests putrefactive 
decomposition, and promotes healing. The alkaloids are destructive 
of the minute organisms, on the presence of which fermentative 
changes depend, and hence, when added to milk, urine, and other ani- 
mal fluids, will prevent decomposition (Binz, Herbst, Baxter, etc.). 
Quinine, the most active of the alkaloids, is not equally destructive of 
all minute organisms : some, it merely inhibits ; others, it kills. The 
bacteria of septic fluids resist its toxic action to a great extent, and 
are only inhibited by the largest quantity. 

When the crude bark is introduced into the stomach, the alkaloids 
are dissolved out by the acid gastric juice, in which they are freely 
soluble. Any portion of the bark, or of the alkaloids, escaping solu- 
tion in the gastric juice, probably, passes out with the other unabsorbed 
contents of the intestine. The alkaline reaction of the intestinal 
juices will cause precipitation of the alkaloids, which, forming insol- 
uble combinations with the bile-acids, will not be absorbed. From 
the stomach the alkaloids diffuse into the blood with facility. In the 
alkaline blood, it is probable that the alkaloids are held in solution by 
the carbonic acid (Kerner). No changes visible by the unassisted 
eye are discernible in the blood, for, notwithstanding the observations 
of the older writers, who affirm that the blood was dark and unco- 
agulable, the moderns deny the existence of such alterations (Briquet, 
Schwalbe). Quinine acts in a definite manner on certain constituents 
of the blood — on the haemoglobin, impairing its power to transport 
active oxygen or ozone, into which the ordinary oxygen of the air is 



CINCHONA. 171 

converted. This is demonstrated in the following manner : Mix with 
old turpentine, that is, turpentine long exposed to the air, and there- 
fore holding ozone, some tincture of guaiacum ; if, now, some haemo- 
globin or a drop of blood be added to the mixture, the tincture of 
guaiacum assumes a blue color, the change of color being due to the 
oxidation of the guaiacum by the active oxygen or ozone contained in 
the haemoglobin (Hermann). The addition of certain substances, no- 
tably of quinine, prevents the reaction ; in other words, destroys the 
ozonizing action of the blood. Binz has shown that so small a quan- 
tity of quinine as one part to twenty thousand exerts this action to a 
considerable extent. As soon as the blood is withdrawn from the 
peculiar influence exerted by the walls of the blood-vessels, as was 
some time ago shown by Pfluger and Zuntz, its alkalinity begins to 
decline, and presently it exhibits an acid reaction. Correspondingly 
with the progress of this acidification, A. Schmidt has shown that the 
quantity of contained oxygen diminishes and the carbonic acid in- 
creases. These changes, leading finally to the death of the blood, are 
greatly retarded by the addition of quinine (Schulte, Binz, Ransone, 
Kerner). From these observations we draw the conclusion that qui- 
nine lessens the oxidizing or ozonizing function of the blood. 

Binz and his pupils have shown that quinine inhibits or lessens the 
activity of the white blood-corpuscles, and indeed destroys them, or 
arrests their production ; for, in cats poisoned by this agent, the num- 
ber of white corpuscles was found to be considerably less than in un- 
poisoned animals (Scharrenbroich, Martin, Jerusalimsky, Geltowsky). 
By all the observers just named, by Baxter, who made a series of very 
carefully conducted experiments, and by Cutter, it has been estab- 
lished that quinine inhibits the amoeboid movements of the white cor- 
puscles. These bodies, as other masses of protoplasm, are in con- 
stant motion, changing their form and appropriating the materials 
of their nutrition. Such movements are called amoeboid, and they are 
arrested by quinine, even in so small a quantity as one part to four 
thousand ; hence it is called a protoplasmic poison. Quinine has also 
the power to prevent or arrest the migration of the white corpuscles 
from the vessels. This Binz was the first to demonstrate, using the 
method employed by Cohnheim for exhibiting the phenomena. This 
is now generally conceded, although denied by Schwalbe ; but, as the 
observations of Geltowsky show, the quantity of quinine necessary to 
produce the result varies with the animal experimented on, and ranges 
from one part in four thousand to one part in eight hundred, outside 
of the body (Appert). No amount, short of a fatal dose, can affect 
the movements of the white corpuscles in the living warm-blooded 
animal, according to Geltowsky, who, therefore, holds to the same view 
as Schwalbe on this point. In opposition to the views of Binz must also 
be placed Schtschepotjaw, who has studied the effects of small quantities. 



172 RESTORATIVE AGENTS. 

Quinine also affects the rate of movement of the heart. An impor- 
tant distinction exists between the action of small and large doses. It 
is a matter of daily observation that ordinary medicinal doses of qui- 
nine (from two to five grains) increase the action of the heart, while 
experiments with large doses have demonstrated that this agent de- 
presses the circulation. Observations on the intra-cranial circulation, 
as seen through the retina and drum membrane, have demonstrated 
that an artificial hyperemia results from the administration of medi- 
cinal doses. On the other hand, as Favier was the first to observe, 
quinine in large doses depresses the heart, arrests it in the diastole 
without impairing its contractility, and lowers the arterial tension 
(Chirone, Briquet). Quinine acts on the cardiac motor ganglia, and 
hence occur the feebleness of the heart's movements and in part the gen- 
eral lowering of the vascular tension (Lewizky). Besides these effects, 
it unquestionably depresses the vaso-motor system, after a short pre- 
liminary stimulation, probably (Jerusalimsky, Lewizky, Briquet). This 
depression of the heart from large doses occurs after the vagi are 
divided (Briquet, Schlockow, Kohler, Lewizky), and is more conspicu- 
ous when the agent is introduced into the jugular vein, indicating that 
the impression made on the heart is not through an increase of inhibi- 
tion, but on the cardiac ganglia. Immersion of the heart in a quinine 
solution quickly arrests its movements. 

In the normal condition of the human subject, quinine does not 
appreciably affect the temperature. In the course of some carefully 
conducted experiments a few years ago, I found that the maximum 
doses caused not more than a half-degree decline in a healthy adult. 
In fever, however, the influence of antipyretic doses is prompt and 
decided. This result may be attributed to several factors : to the de- 
pression of the heart and arterial tension, to the suspension of the 
oxidizing power of the blood, and to the inhibition of the white cor- 
puscles. Jiirgensen was the first to observe that quinine prevented 
the rise of temperature produced by certain physiological acts, as, for 
example, active exercise, but Kerner has more particularly developed 
the experimental evidence proving this fact. By active gymnastics, 
the temperature was found to be elevated two to three degrees Centi- 
grade ; but the previous exhibition of a full dose of quinine prevented 
this rise of the body-heat. Kerner also ascertained that the increased 
cutaneous secretion, the result of active exercise, was prevented by 
the administration of sufficient quinine. From all of these facts, it 
seems evident that the lowering of the temperature by this agent de- 
pends on diminished production of heat rather than increased radia- 
tion and loss by cooling of the skin. This statement seems confirmed 
by the experiment of Lewizky, made in Hering's laboratory, by wrap- 
ping a rabbit in protective envelopes to prevent loss of heat by cool- 
ing, and then practicing the intra-venous injection of quinine ; the re- 



CINCHONA. 173 

suit was a depression of temperature as in animals not so enveloped. 
To such experiments, the author opposes the insuperable objection 
that the temperature in rabbits kept at rest declines, and to a remark- 
able extent, without the administration of any medicament. Never- 
theless, the fact of the reduction of temperature by quinine is un- 
doubted. By Popow, who admits the diminution of temperature, the 
influence of quinine over the body-heat is referred to some unknown 
biological process. 

In small doses quinine exerts a distinct stimulant effect on the 
cerebrum, increases the mental activity, and even exhilarates in some 
mobile constitutions. As some hyperemia is caused by it, the result- 
ing cerebral stimulation is probably secondary to this change in the 
vascular condition. In full medicinal doses, as the quinine accumu- 
lates in the brain, a sense of fullness in the head, constriction of the 
forehead, tinnitus aurium, more or less giddiness, even decided ver- 
tigo, may be produced. Dullness of hearing results from considerable 
doses, and deafness has in rare cases been permanent. In a long ex- 
perience of its use and extended observation, no case has come under 
my notice of permanently impaired hearing, although the temporary 
condition is usual. According to Knapp, Moos, and others, amaurosis 
is produced by very large doses. White atrophy of the optic disks 
occurs, and most of the vessels disappear from the field. This must be 
due to strong contraction of the vessels, since this condition is quite 
curable, the ordinary appearance of the retina being restored in most 
of the cases. Permanent atrophy of the optic nerve is, however, an 
occasional result. Amblyopia is frequently produced by the use of 
considerable doses kept up for some time. It is recovered from readily 
by suspending the administration of the remedy and taking the neces- 
sary steps to improve the intraocular circulation. In actually toxic 
doses all of the above symptoms have been intensified. There are in- 
tense headache with constriction of the forehead, dimness of vision or 
complete blindness, deafness, delirium or coma, dilated pupils, weak, 
fluttering pulse, irregular and shallow respiration, convulsions, and 
finally collapse and death. It is excessively rare to encounter such 
severe cerebral symptoms. 

The influence of quinine over the functions of the spinal cord is 
yet subjudice. Chaperon some time ago demonstrated that quinine 
lessened and ultimately abolished the reflex function of the spinal 
cord. This result he decided was due not to immediate action on the 
spinal cord, but to stimulation of Setschenow's center of inhibition of 
reflex movements. Brunton, who has repeated Chaperon's experi- 
ments, has found them to be correct. The observation of Schlockow, 
that the first effect of quinine is to increase the sensibility of the re- 
flex function of the spinal cord, has much probability in its favor. 
Heubach has also, after moderate doses, observed some evidences of 



174 KESTOKATIYE AGENTS. 

the existence of reflex irritability, but the experiments of Brunton 
show that these reflex effects decline with the increasing stimulation 
of the inhibiting center. Brunton's experiments were also directed 
to ascertain whether the sulphuric acid in combination with the qui- 
nine was responsible for the effects observed, but the result proved 
that quinine is the active agent in stimulating Setschenow's inhibiting 
center. 

As quinine depresses the functions of the sympathetic system, its 
action is opposed to that of agents which have the power to promote 
uterine contractions, hence, a priori, it would not seem to be aborti- 
facient. Very numerous and conflicting statements have been put 
forth, because there are no exact data. The few cases in which uter- 
ine action followed the administration of quinine were, doubtless, due 
to malarial intoxication or to other causes, and hence the association 
of uterine action with the effects of quinine was accidental. The in- 
numerable instances in which quinine has been given during the exist- 
ence of pregnancy, without initiating contractions of the womb, are 
certainly conclusive against the view of its abortifacient power. 
While it is not a special uterine stimulant, it may exert such an ac- 
tion indirectly. When uterine inertia is due to depression of the vital 
forces, quinine, in moderate doses, then becomes a valuable stimulant, 
and is utilized for this purpose in obstetric practice. 

The diffusibility of quinine and its rate and mode of elimination 
have been studied by Bence Jones, Ciotti and Albertoni, and Kerner. 
Jones in his researches availed himself of the fluorescent property of 
animal tissues, possessed also in a high degree by the alkaloids of cin- 
chona, especially quinine. To this substance, as it appears in animal 
tissues, Jones gave the name " animal chinoidin," but he was not aware 
that fluorescence is a property possessed by large numbers of animal 
and vegetable bodies. Nevertheless, he recognized the fact that the 
diffusibility of quinine could be estimated by the increase in the fluo- 
rescence of animal textures, and he thus ascertained that in a half- 
hour after the administration of quinine a positive gain in fluorescence 
of the crystalline lens is observed. It is probable that under some 
circumstances — a catarrhal state of the mucous membrane, for exam- 
ple — a portion of the quinine taken fails to be absorbed, and is conse- 
quently excreted by the intestines (Byasson). The effect of this 
agent on the secondary assimilation is involved in more or less doubt. 
Opposing opinions have arisen from the different points of view taken. 
In the normal condition quinine, in small quantity, stimulates the nu- 
trition, and increases the excretion of waste products — urea, uric acid, 
creatinin, extractives, etc. ; but, in considerable doses, the opposite 
condition obtains — the decrease in the quantity of uric acid is espe- 
cially well marked (Ranke, Kerner) — and when administered in mala- 
rial fevers all the products of waste are greatly increased. The con- 



CINCHONA. 175 

ditions attending the use of the remedy, therefore, influence the re- 
sult. Considerable doses in the normal state diminish the excretion 
of urea, uric acid, creatinin, and phosphoric and sulphuric acids 
(Kerner). Strassburg, however, failed to find any change in the car- 
bonic acid. According to the observations of Cutler and Bradford, 
quinine has an obvious effect on the globular richness of the blood, 
increasing the relative proportion of the white, and diminishing the 
red globules. The action of quinine on the spleen is still sub judice. 
Piorry was the first to note a reduction in the size of the organ pro- 
duced by quinine, but he had an exaggerated notion of the nicety by 
which a difference in the size of an organ could be made out by the ples- 
simeter and hammer. Kuchenmeister examined the subject experi- 
mentally in 1851, with negative results, but afterward, operating 
with larger doses, obtained confirmation of Piorry's view. Mosler, after 
dividing all the nerves of the spleen, ascertained that quinine in large 
doses still acted on the contractile elements, and reduced the size of 
the organ. Jerusalimsky, in an elaborate research, has established 
the same fact. That the enlarged spleen of malarial infection is re- 
duced by quinine is an undoubted clinical fact. From these positive 
observations it must be concluded that quinine does act on the spleen, 
notwithstanding there are numerous negative statements. It follows, 
hence, that the diminution in the red and increase of the white cor- 
puscles may be due to this action. 

Quinine diffuses out of the blood into the urine, chiefly, but also 
into the sweat, saliva, milk, and pathological exudations '(Kerner, 
Briquet, Binz). Jtirgensen found quinine in the urine in ten minutes 
after the hypodermatic injection. Thau had evidence of its presence 
in the urine in a half-hour after the ingestion of a half -drachm dose 
each by two persons, and he holds that the maximum elimination takes 
place in about eight hours, but the excretion is not completed until 
two days after the administration. According to De Renzi, quinine 
remains in the organism a variable number of days, and may indeed 
be discovered in the urine on the third day ; in a special case, as late 
as seven days. Binz also finds that the elimination of quinine is vari- 
able and rather slow, the maximum being excreted within forty-eight 
hours. From the time the agent appears in the urine, the systemic 
action is manifest, and the maximum effect of any given dose must 
be experienced in advance of the period of maximum elimination, 
which Thau places at eight hours. According to Kerner, quinine ap- 
pears in the urine in a somewhat modified form. 

The action of quinine has occasionally been attended by the ap- 
pearance of an eruption on the skin. Sometimes the exanthem has 
been in the form of an erythema, sometimes it has assumed the ap- 
pearance of urticaria ; again, it has seemed to be herpetic. There is, 
in fact, no constant and invariable eruption, and many of the reported 



176 RESTORATIVE AGENTS. 

cases are open to the suspicion that the appearances on the skin are 
merely accidental, and not causative. 

Therapy. — A solution of quinine will sometimes, when applied to 
the nares, arrest an attack of summer catarrh, a malady which appears 
to be produced by the pollen of plants. The preparation most suitable 
for this purpose is an aqueous solution of the hydrochlorate (gr. iv — 
gr. viij — § j). This should be applied by a large camel's-hair brush, 
or spray-producer, to the nares and fauces. The utility of quinine in 
this peculiar disease will be determined by the extent to which the 
local trouble has proceeded ; it can be useful only when the irritation 
is confined to the nares and fauces. 

The aphthous ulceration (muguet) which succeeds to an exhausting 
entero-colitis, or which occurs in cachectic infants, is much improved by 
quinine — a grain or two every three hours. An attack of acute tonsillitis 
may sometimes be aborted by a full dose of quinine (ten to fifteen grains). 
This practice is especially indicated in those cases which proceed to 
suppuration, but the quinine must be administered before pus forms. 

The preparations of cinchona are much used as stomachic tonics. 
In atonic dyspepsia they are employed, like the simple bitters, to pro- 
mote the flow of gastric juice. In gastric catarrh they relieve that 
morbid state of the mucous membrane on which the increased produc- 
tion of mucus depends. For these purposes they may be combined 
with the mineral acids. The best preparation is the infusion ; the de- 
coction, although official, is inelegant and faulty. The alkaloid quinine 
is frequently used for the same purposes, and notably in the gastric 
catarrh of drunkards, combined with acids. When vomiting of yeast- 
like material is due to the presence of sarcina, quinine may be used 
in virtue of its power as a poison to these minute organisms, and as 
an anti-ferment. In these stomach-disorders other and less expensive 
drugs may be used with equal advantage. (See Hydrastis.) When 
there is a relaxed state of the gastro-intestinal mucous membrane, 
manifested by catarrh, diarrhoea, etc., but without inflammation, the 
preparations of red bark are more particularly indicated in virtue of 
the tannins which they contain. The reader need hardly be reminded 
that the preparations of cinchona are contraindicated in all inflam- 
matory states of the intestinal mucous membrane. Furthermore, if 
too long continued, they will set up an irritation, and perpetuate the 
troubles which they were prescribed to remove. 

Sometimes it happens that the entero-colitis of children (cholera 
infantum), which resists every possible combination of astringent and 
laxative, will yield readily to quinine. The author has seen quinine 
give prompt relief in the following : A child suffers with tenesmus, 
and after much straining voids a transparent mucus streaked with 
blood, but there is no fever nor other disturbance of the bowels, and 
the stools when passed are natural. 



CINCHONA. 177 

The preparations of cinchona and quinine are very serviceable in 
that state of the mucous membrane which favors the development of 
ascarides. After the expulsion of the parasites, these remedies remove 
the saburral state of the mucous membrane. A combination of purga- 
tives and bitters will correct the following condition of things as they 
occur in children : A foul breath, coated tongue, capricious appetite, 
tumid belly, and constipation alternating with diarrhoea. 

The use of quinine as a restorative tonic in cases of debility is al- 
most universal. Given in moderate doses — six to twelve grains a day 
— it promotes constructive metamorphosis. Its utility is due not to 
any direct action on the blood, but to its stimulant effect on the 
digestive function, and the retardation of the combustion process. 
When cinchona or quinine proves irritant to the intestinal mucous 
membrane, this beneficial restorative action ceases. Iron and arsenic 
increase the power of quinine to promote construction of tissue and to 
retard waste. 

There can be no doubt in regard to the power of quinine to arrest 
the inflammatory process in its formative stages. Its utility, given 
with this view, ceases when the migration of the white corpuscles and 
the proliferation of the cellular elements of the inflamed parts have 
taken place, for it possesses no power to cause disintegration and ab- 
sorption of inflammation products. Administered at the critical mo- 
ment, a commencing fibrinous pneumonia, a pleuritis, an endocarditis, 
may be suppressed by a full dose (twenty to forty grains). Its power 
in this respect is much increased by combination with morphine. If the 
time have passed for the use of quinine in this way, it is employed with 
advantage as a restorative tonic in the various inflammatory affec- 
tions of low type, small doses (two to four grains) being given fre- 
quently. 

In septic diseases quinine has very important uses. Although the 
observations of Binz, showing the influence of quinine over septic pro- 
cesses, may not be applicable to the full extent for which, he proposes 
them, there can be no doubt of the good effects in practice of quinine 
in septicemia, pyemia, erysipelas, and puerperal fever. In these dis- 
eases, only large doses — five to twenty grains — every four hours, are 
useful. 

The author's experience in the treatment of acute rheumatism does 
not justify the use of large doses of quinine, as now employed by Bri- 
quet and his followers in France. In the hyperpyrexia of acute rheu- 
matism, it is true, large doses of quinine will depress the temperature, 
but we have less distressing and more effective means for accomplish- 
ing this object in the wet-pack and the cold bath. When the acuter 
symptoms have subsided, and the skin is cool and perspiring, and the 
pulse weak, quinine in moderate doses — two to five grains — is very ser- 
viceable. 

12 



178 RESTORATIVE AGENTS. 

A careful examination of the large number of facts which have 
now been accumulated, and considerable personal experience and ob- 
servation, have satisfied the writer of the inutility of quinine as a 
means of aborting or shortening the duration of typhus and typhoid 
fevers. Not only has this remedy little or no influence over the 
course and duration of these affections, but its irritant effects upon 
the gastro-intestinal mucous membrane, and its inhibitive influence, 
exerted through the organic nervous system, upon the heart and lungs, 
may, in some cases, render it positively injurious in large doses. As 
a rule, the dryness of the tongue, the diarrhoea, the subsultus, and the 
delirium of typhoid fever, are increased by it. In certain parts of the 
United States, the prevalence of a mixed type — typho-malarial — re- 
quires, under certain conditions, the use of quinine in continued fevers. 
But it becomes less and less effective as the typh-element predominates. 
When there are evidently true remissions — and not merely the rhyth- 
mical morning remission and evening exacerbation characteristic of 
typhoid — quinine is indicated, and it is most effective when adminis- 
tered in an occasional large dose during the remission. When there 
is a condition of hyperpyrexia, or of continuously elevated tempera- 
ture, which endangers life by parenchymatous degeneration and car- 
diac or cerebral paralysis, quinine in antipyretic doses renders an 
incontestable service. This opinion of the author is fully confirmed 
by the committee of the Clinical Society of London, who find that 
large doses of quinine have a marked effect in reducing the temperature 
in pyrexia, and that, although, with the exception, perhaps, of certain 
cases of rheumatic fever in which the temperature is high, no decided 
evidence has been obtained to show that quinine has any influence in 
shortening the attack of a specific disease such as typhus or scarlet 
fever, yet from the marked effect on the temperature and pulse there 
is reason to believe that at the critical stage of acute disease, when 
pulse and temperature are high, a large dose of quinine may be em- 
ployed with benefit. Jiirgensen, Ringer, Liebermeister, and other 
authorities, and a vast clinical experience in all civilized countries, are 
now agreed in respect to the fever-reducing power of quinine and to 
the absence of ill results from large doses (especially Liebermeister). 
Liebermeister, indeed, says, if he were restricted in his choice to one 
antipyretic, he would select quinine. The quantity necessary to effect 
a decided reduction of the body-heat in fevers is determined by the 
age, the amount of disturbance, and the individual susceptibility to 
its action. In general, it may be stated that from twenty to sixty 
grains will be required. The antipyretic effect is more decided if it 
is given toward the close of the exacerbation or during the remission 
in typhoid or other fevers. The duration of the effect is " from one 
to forty-eight hours " ; consequently, a repetition of the dose will be 
necessary, if it is desired to maintain the reduction of the temperature. 



CINCHONA. 179 

A few large doses at short intervals until the necessary quantity is 
reached, or a single maximum dose if the stomach is tolerant, should 
be prescribed, rather than a succession of smaller doses. The rapidity 
with which elimination takes place is a sufficient reason for adopting 
the former mode of administration. The effect of quinine is not less 
happy in the fevers of childhood, and comparatively large doses are 
well borne at this period, as Jacobi, especially, has shown us. The 
same rule should be followed as in the case of adults : to give the 
amount required in several doses within a brief period — an hour, ac- 
cording to Liebermeister — or at one time. The antipyretic use of 
quinine should not be confounded with its tonic or supporting quali- 
ties. In the treatment of fevers, the typhoid state, or the condition 
of adynamia supervening during the course of fever, small doses (two, 
three, or four grains), at short intervals, are employed for the stimu- 
lating effects which they have on the organs of circulation, respira- 
tion, and digestion. Large doses, as has been set forth, depress these 
functions. 

In cerebrospinal meningitis, doubtless a continued fever with cere- 
brospinal lesions, quinine is indicated under the conditions already de- 
fined for the treatment of other inflammations, viz., in the beginning 
of the disease, when the alterations of cutaneous sensibility first occur, 
and before the febrile movement has developed. If a few large doses 
— twenty to thirty grains — do not produce a good result, it is useless 
to repeat them, or to pursue a tentative plan with small doses. 

In the treatment of the eruptive fevers, variola, scarlatina, rubeola, 
quinine has an important place. It is used in small doses, frequently 
repeated in adynamic states, and in large doses at longer intervals to 
reduce hyperpyrexia. In scarlet fever, Dr. Hood especially urges the 
use systematically of quinine from the earliest stage of the disease, 
preceded by an emetic and purgative, and he states as the result of this 
practice that since he has adopted it he has not lost a single case of 
this disease treated by him from the beginning. In measles, large doses 
of quinine have an unquestionable utility in relieving the catarrhal 
pneumonia, and in preventing those changes in the exudation products 
which end in caseation. 

The most important uses of quinine are those which, in the present 
state of our knowledge, can not be deduced from a study of its physi- 
ological actions, viz., the cure of malarial diseases. It is true, the 
toxic action of quinine on minute organisms is supposed by Binz and 
his followers to be the true explanation of its methodus medendi, but 
the exact influence of these organisms in the causation of malarial 
diseases has not hitherto been defined. The recent discovery of the 
bacillus malarim by Klebs and Tommasi-Crudeli, if confirmed, will 
afford the needed explanation. The power of quinine to render in- 
active the minute organisms of disease must also be exerted against 



180 RESTORATIVE AGENTS. 

the malaria-germ. Other agents possess this power, it is true, but 
they are, unlike quinine, destructive of the tissues as well as of the 
disease-germs. 

The alkaloids of cinchona are employed as prophylactics against 
malarial infection. The experience of the English naval service, of 
crews engaged on the coast of Africa in the suppression of the slave- 
trade, of the expeditionary force into Ashantee under Lord Napier, and 
of our late civil war, has abundantly shown that quinine is in a high 
degree prophylactic. The first public reference to this property seems 
to be that of Dr. Bryon in 1854, who called attention to the success 
which attended its use among the crews of the British vessels serving 
on the coast of Africa. Since that time, for several years the statistical 
reports of the British naval medical service have contained conclusive 
evidence on this point. Dr. Joseph Jones has published since the close 
of the civil war some valuable statistical data, showing the efficiency 
of quinine as a prophylactic. The troops who were the subjects of ex- 
periment were stationed in a highly malarious locality. Of the num- 
ber, 230, who took no quinine, 134 had fever. Of those who took qui- 
nine irregularly, 246 in number, 96 had fever. Of the 506 who took 
quinine regularly, 98 had fever. The proportion of cases of fever was, 
therefore, 1 to 5*66 men. On the coast of Africa, the proportion has 
varied from 1 in 8 to 1 in 20. Of the unprotected, more than one half 
— on the coast of Africa, three fourths — were attacked by malarial 
disease in some form. As the quantity of quinine daily taken has 
been usually three to five grains, it is probable that the results would 
be even more favorable if a larger quantity of the prophylactic were 
given. When the poison is not intense, this amount may be sufficient, 
but if concentrated and active, and the conditions are otherwise un- 
favorable, twice as much should be administered daily. An enor- 
mous experience has now shown that quinine is entirely free from in- 
jurious effects when taken as a prophylactic. It is probable that the 
influence slowly decreases, and that some addition to the daily quantity 
may be necessary after a time. The prophylactic dose should be ad- 
ministered on rising in the morning, and may be usefully prescribed 
in a cup of black coffee, or in pill-form. The practice adopted in the 
civil war, of giving whisky as the vehicle, is not to be commended. 
If the quinine administered fail to prevent the disease, those attacked 
will suffer far less severely than the unprotected. Experience has 
shown that, to be entirely efficient, the quinine must be administered 
for some time, at least ten days, after exposure to the causes of fever 
(Jones). 

The mode of using quinine for the cure of intermittents may be 
formulated as follows : 

The antipyretic is nearly equally effective whether administered in 
the interval or during the seizure. 



CINCHONA. 181 

If time is an element of importance, no delay is necessary in order 
to give the remedy in the stage of apyrexia. 

To save the suffering and exhaustion of the febrile movement, the 
attack should be anticipated, and, if possible, prevented. 

As the maximum effect of the quinine is attained in about five 
hours after being taken, it should be administered this period of time, 
at least, before the expected paroxysm. 

As the elimination of quinine takes place with considerable rapid- 
ity, the maximum curative effect is obtained by the administration of 
the whole amount required in a single dose, rather than by a succes- 
sion of small doses (Prize Essay). 

An intermittent may be successfully treated by giving, during the 
interval, a number of small doses frequently repeated. The author is 
convinced by extended observation that a full dose of quinine (ten 
grains) in the sweating stage, and the same quantity five hours before 
the time of the next paroxysm, is the more effective method. The 
anti-periodic property of quinine is increased, and the cerebral effects 
of large doses diminished, by combination with morphine. It is well 
known that intermittents, arrested by quinine or other anti-periodics, 
manifest a tendency to recur about the septenary periods ; therefore, 
ten to fifteen grains of quinine should be administered in anticipation of 
these recurrent paroxysms, until the third septenary period has passed. 
Meanwhile, the organs damaged by the malarial infection — intestinal 
canal, liver, spleen, kidneys, etc. — require appropriate treatment. The 
action of quinine is much assisted by the continuous administration of 
arsenic during the intermissions, and until the third septenary period 
has passed. The unpleasant cerebral effects of quinine are lessened or 
prevented by the simultaneous administration of diluted hydrobromic 
acid : I£ Quininse sulph., 3 j ; acid, hydrobromic. dil., 3 ij ; aquae, 
3 xiv. M. Sig. : One or two teaspoonf uls at a dose. 

In the treatment of remittent fever two modes of using quinine are 
employed : first, by emetics, purgatives, baths, diaphoretics, etc., to 
secure a distinct remission when the remedy is administered ; second, 
to give it in sufficient dose immediately, relying on its apyretic effect. 
The author is convinced that the latter plan is preferable: from twenty 
to thirty grains in a single dose once or twice each day until the tem- 
perature is reduced to normal. This use of the remedy need not inter- 
fere with other appropriate medication. 

In the so-called pernicious fever, it is agreed on all hands that the 
safety of the patient is secured only by the prompt use of large doses 
(twenty to sixty grains), and administration by the stomach, rectum, 
and skin may be in turn or simultaneously resorted to. 

In chronic malarial infection, important changes have been pro- 
duced in the intestinal canal, liver, spleen, kidneys, cerebro-spinal axis; 
the paroxysms of fever occur irregularly ; various abnormal manifes- 



182 RESTORATIVE AGENTS. 

tations of the infection take place (dumb ague, enlarged spleen, etc.). 
Under these circumstances, quinine is less curative than when the infec- 
tion is recent, and the paroxysms will recur from time to time notwith- 
standing its use, unless these structural alterations are corrected. In 
chronic malarial disease, salicylate of quinine and salicylate of cincho- 
nidine are especially effective, fy Cinchonidinae salicylat., 3 ij ; acidi 
arseniosi, gr. j ; ferri sulph. exsic, 3 j. M. Ft. pulv. (wafers) no. xx. 
Sig. : One three times a day. Also: r> Chinoidin., 3 ij; quininge salicy- 
lat., 3 j; ferri sulph. exsic, 3j. M. Ft. pil. no. lxxx. Sig.: Two pills 
three times a day. £> Quininse sulph., chinoidinse, aa 3 j ; res. podo- 
phylli, gr. v; ferri sulph. exsic, 3 ss. M. Ft. pil. no. lx. Sig.: Two 
pills three times a day. 

In periodical affections of malarial origin, quinine is equally as ef- 
fective as in the periodical febrile diseases, but somewhat larger doses 
are necessary. A difficulty of diagnosis often arises in these diseases, 
for the reason that the neuroses are irregularly periodical in their 
manifestations, when not malarial in origin. The existence of a ma- 
larial cachexia, and the more uniform periodicity in the recurrence of 
the paroxysms, will enable the practitioner to distinguish the neuroses 
of malarial origin from the other functional disorders of the nervous 
system. The following group contains the disorders of the sensory 
nervous system caused by malaria : tic-douloureux, cephalalgia, cer- 
vico-brachial neuralgia, cervico-occipital neuralgia, dorso-intercostal 
neuralgia, lumbo-abdominal neuralgia, mammary neuralgia, crural neu- 
ralgia, gastralgia, enteralgia, hepatalgia, nephralgia, hysteralgia, ova- 
ralgia, sciatica, angina pectoris. The following motor disorders, also, 
are produced by malarial influences : epilepsy, chorea, stricture of 
urethra, hiccough, laryngismus stridulus, asthma, summer catarrh. 
These neuroses may occur as an expression of malarial infection, 
being substituted for the ordinary chill, fever, and sweat, or they may 
assume the orderly periodical character in consequence of having 
occurred in an organism already under the influence of the malarial 
cachexia. If they are of malarial origin, the specific action of quinine 
will speedily prevail against them. These malarial neuroses require 
large doses of quinine, and the same fact is true of all irregular mani- 
festations of malarial infection. Ten to twenty grains, according to 
the severity of the attacks and the obstinacy with which they recur, 
are necessary, and the paroxysms should be anticipated by the exhi- 
bition of the remedy from three to five hours before the expected time. 
In cases of malarial neuralgia, the curative effect of quinine is enhanced 
by combination with morphine, either in the same prescription or by 
simultaneous administration of the latter subcutaneously. 

Diarrhoea, dysentery, jaundice, and hypertrophy of the spleen oc- 
casionally occur in the periodical form, or are due to the immediate 
influence of paludal miasm. Under these circumstances quinine af- 



CINCHONA. 183 

fords relief without the use of any other remedy. Very frequently the 
diarrhoea, dysentery, and jaundice are results of structural alterations 
in the liver and the glandular apparatus of the intestine, and are not 
merely functional disorders which quinine may remove. In malarial 
enlargement of the spleen, quinine is supposed to be especially effec- 
tive ; but quinine exhibits a curative power only in cases of simple 
enlargement, and does not affect that condition known as " fleshy 
spleen," or chronic splenitis, of inflammatory origin. 

Hematuria, when distinctly intermittent and arising from malarial 
infection, is cured by quinine, but large doses are necessary. Accord- 
ing to Karamitsas, sometimes hematuria is caused by this agent. 

Cases of cerebral disease, occurring in weak and anaemic subjects, 
are sometimes much improved by small doses of quinine. The author 
has observed great relief by the use of this remedy in the following 
group of symptoms, occurring in men advanced in life : Headache, 
vertigo, failure of memory, and despondency, associated with a slow 
pulse, an atheromatous degeneration of the vessels, puffiness of the 
eyelids, and dilatation of the superficial veins of the head. From 
three to ten grains daily may be given with advantage, the effect being 
to remove that sluggishness of the intra-cranial circulation on which 
these symptoms depend. In insanity, especially the puerperal form, 
when there is much weakness, and the skin is cold and sweating, qui- 
nine is very useful. When there is a condition of adynamia — the usual 
state — in delirium tremens, small doses of quinine assist materially in 
tranquillizing the patient. In that preliminary stage known as " hor- 
rors," characterized by restlessness, tremor, nausea, and anorexia, qui- 
nine, with a mineral acid, renders important service by restoring the 
digestive function, and by giving steadiness to the cerebral motor 
centers. 

Although headache (hemicrania) and neuralgia of malarial origin 
are cured by quinine, by no means equally successful results follow 
the use of this remedy in ordinary headache and neuralgia. Quinine 
is largely employed, it is true, in these affections when not caused by 
malaria, but it is useful only when anaBmia is present and is causative. 
The same remark is true of epilepsy and chorea. 

An attack of acute catarrh may often be entirely aborted by a 
full dose (ten grains) of quinine and morphine (one half a grain), if 
given at the incipiency of the attack. After the acute symptoms have 
subsided, quinine is very serviceable in hay-asthma. Diphtheria being 
an adynamic disease, quinine is used by the stomach with a view to 
its restorative action, and in the form of spray to arrest the spread of 
the exudation in the fauces. The power of quinine to kill bacteria 
and micrococci renders its local use a rational measure in a disease 
characterized by an enormous multiplication and diffusion of micro- 
cocci. 



184 RESTORATIVE AGENTS. 

Laryngismus stridulus, a reflex spasm of the muscles of the larynx 
occurring in rickety, ill-fed, and anaemic children, may be prevented 
recurring by the use of quinine in the intervals between the attacks. 
Quinine is one of the remedies which is used in membranous croup, 
but the reported successes were probably cases of spasmodic croup. 
There can be no doubt regarding the good effects of quinine in asth- 
ma, after the severity of the paroxysms has somewhat abated, as an 
apyretic in the fever which succeeds, and as a restorative tonic. It is 
also the most useful tonic which can be employed in chronic bron- 
chitis, with profuse expectoration (bronchiectasis). The hectic fever 
and sweats of phthisis are prevented by large doses (fifteen to twenty 
grains) of quinine, but this remedy really has no influence over the 
course and progress of the disease. 

In shin-diseases, when there is present a lowered condition of the 
vital forces, quinine is indicated. It is the most valuable remedy in 
erysipelas and erythema nodosum. It is a curious fact that in many 
subjects a full dose of quinine will cause an erythema, with dilated 
pupils, phenomena closely analogous to those produced by belladonna. 
Ecthyma and impetigo, usually arising in a feeble state of the assimi- 
lative functions, are cured by quinine. 

Quinine is largely employed in surgical affections, to sustain the 
powers of life during protracted suppuration, and to check the forma- 
tion of pus. It is the most generally prescribed remedy for surgical 
fever. A full dose of quinine, given before the operation, may pre- 
vent the chill and fever which succeed in some subjects to the opera- 
tion of catheterization. 

Subcutaneous and Local Uses of Quinine. — The increasing use 
of quinine hypodermatically requires further consideration of this sub- 
ject. In pernicious intermittens and remittents, when life is put in 
imminent danger, the most speedy and effectual way of introducing 
the remedy must be employed. Besides the hazards due to the inten- 
sity of the poison, an irritable stomach and rectum prevent the intro- 
duction of the remedy by either of those channels. The subcutaneous 
method then becomes most important. Again, in obstinate and re- 
peatedly relapsing intermittents, the introduction of the remedy by 
the skin imparts to it greater curative power. In enlarged spleen 
(ague-cake), malarial jaundice, with great irritability of the stomach, 
and a catarrhal state of the gastro-intestinal mucous membrane, the 
subcutaneous method becomes necessary, or, if not essential, is much 
more effective. Quinine and the sulphate simply suspended are not 
adapted to subcutaneous use. Several cases of tetanus have been 
reported from New Orleans (Sale), and two cases occurred in one 
regiment of the British Indian Army from their use in this way. 
The salt employed for hypodermatic use should be sufficiently solu- 
ble that no undissolved particles be thrown under the skin. Various 



CINCHONA. 185 

solutions have been proposed. The muriate is more soluble than the 
sulphate — dissolves in twenty-four parts of cold water, and about 
three parts of alcohol. One grain will dissolve in about fifteen min- 
ims of hot water, and in a much less quantity of alcohol-and-water, 
but alcohol is irritating. Lente's solution, which is much employed 
in New York, is prepared as follows : I£ Quininae disulph., grs. 1 ; 
acid, sulphuric, dil., in, c ; aquas font., | j ; acid, carbolic, liq., tti v. 
Solve. This contains six grains to the drachm. Dr. Lente directs that 
the quinine and water be heated to the boiling-point when the acid is 
added. The solution is then filtered into a bottle and the carbolic acid 
added. Below 50° Fahr. it must be warmed before using. A solution 
of kinate of quinine is much used at Guy's Hospital at the strength 
of one to four. The kinate is obtained by decomposing sulphate of 
quinine with the kinate of barium. The mode of preparing the solu- 
tion is as follows : Put into a beaker 3 vj of distilled water and 3 ij of 
kinate of quinine, and heat until the salt dissolves, which it does al- 
most immediately, and then add enough distilled water to make up to 
5 j. The disadvantage of so concentrated a solution is the incrusta- 
tion, by evaporation, of the bottle and syringe with the solid kinate. 
The sulpho-vinate of quinine is very soluble — one part in three of 
water at 60° Fahr. — and is readily prepared by double decomposition 
between the alcoholic solutions of sulpho-vinate of sodium and sul- 
phate of quinine. Gubler advocates the hydrobromate, as follows : 
I£ Quininaa hydrobromat., grs. xlviij ; aquae destil., 3 iv. M. Dis- 
solve by heat if necessary. Five minims contain one grain. 

Recently a new compound salt of urea and quinine has been pro- 
posed, and it seems to possess distinct advantages over every other 
preparation : it is designated quinia bimuriatica carbamidata, and is 
formed by Drygin from a combination of twenty parts of muriate of 
quinine, twelve parts of muriatic acid, and three parts of urea. The 
resulting salt is soluble in equal parts of water. The utility of this 
compound is not entirely theoretical. Practical trials made at Ham- 
burg have demonstrated its fitness for hypodermatic use. A fifty-per- 
cent solution has usually been employed, and a half to three syringefuls 
(ill xv to 3 jss) injected. The local irritation is represented as slight. 
Very favorable reports have been published in respect to the utility of 
the hydrobromate brought forward by Gubler. In the hands of Ray- 
mond, Soulez, and others, intermittents are said to have ceased after 
two injections of three grains each of this salt. The usual method 
pursued was to inject one and a half grain of the hydrobromate twice 
morning and evening, and, although six to twelve grains were usually 
successful, in one case thirty grains were required. It has also been 
employed in the treatment of acute rheumatism. 

Quinine in solution is applied in various affections of the fauces by 
atomization. In diphtheria especially have good results been produced. 



186 RESTORATIVE AGENTS. 

A saturated solution of the muriate or of the bromide may be thus 
employed. There can be no doubt that a solution of quinine applied 
to the nares may be very beneficial at the onset of hay-asthma, as 
first shown by Helmholtz. The author has seen several cases benefited 
greatly ; but to achieve success the applications must be thorough and 
timely. The secret of any good effects it has, is afforded by its toxic 
action on germs, and possibly on the pollen of certain grasses, to the 
presence of which the irritation of the air-passages is ascribed. As 
soon as the first symptoms are experienced, the mucous membrane 
should be cleared of mucus by means of a nasal syringe, throwing a 
solution of common salt, muriate of ammonia, or chlorate of potassa, 
and then the quinine solution should be applied by a camel's-hair brush 
to the anterior nares, or by the post-nasal syringe to the whole canal. 

Authorities referred to : 

Appert, Dr. J. Virchowh Archiv, Band lxxi, p. 364. Per Einfluss des Chinin auf 
die Auswanderung der weissen Blulkbrper bei der Entzundung. 

Bartholow, Dr. R. Russell Prize Essay — On Quinine, Hartford, 1868. 

Baxter, Dr. E. Buchanan. The Practitioner, London, November, 1873. The Action 
of the Cinchona Alkaloids on Bacteria, etc. 

Binz, Prof. Dr. Carl. Papers on the Actions of Quinia in Virchow's Archiv, Band 
xlvi, pp. 67 and 129 ; in the Perl. klin. Wochen., No. 46, p. 556, and Nos. 47, p. 564, and 
48, p. 575, 1871 ; and in Archiv fur experimentelle Pathol, und Pharmacol., vol. i, p. 18, 
and vol. vii, p. 275. 

Briquet, Dr. Traite Therap. du Quinquina, Paris, 1855; and Bull. Gen. de Therap., 
vol. lxxxiii, p. 289. 

Brunton, Dr. T. Lauder. St. Bartholomew' 1 s Hospital Reports, vol. xii. On the In- 
fluence of Quinine on the Reflex Functions. 

Byasson, Dr. H. Journal de Therapeutique, vol. xiv, p. 526, 1880. Etude sur V elimi- 
nation par les urines des quatre alcaloides principauz de quinquina, ingeres d Vetat de 
sulphates basiques. 

Chirone, Dr. Vincent. Gazette Hebdomadaire, 1875. Mechanisme de V action de la 
quinine sur la circulation. 

Ciotto and Albertoni. Bull. Gen. de Therap., May 15, p. 430, and August 30, p. 360, 
for 1876. Stir les voies d> elimination et d 'action elective de la quinine. 

Colin, Dr. Leon. Bull Gen. de Therap., July 15 and 30, 1872. J^tude sur les sels de 
quinine, de leur action physiologiques et medicate. 

Cutter and Bradford. The American Journal of the Medical Sciences, October, 
1878, p. 367. 

Geltowsky, Dr. The Practitioner, June, 1872. On the Action of Quinine on the 
Colorless Blood- Corpuscles. 

Herbst, Dr. H. Piss. Bonn. Virchow und HirsclCs Jahresbericht. Beitrage zur 
Kenntniss der antiseptischen Eigenschaften des Chinins. 

Heubach, Dr. Central, fur die med. Wissensch., 43, 673, Virchow und HirscWs Jahres- 
bericht, vol. i, 1874. Also, Archiv fur experimentelle Pathol, und Pharmacol., vol. v. 
EinwirJcung des Chinins auf das Nervensystem. 

Jerusalimskt, Dr. Nic. Ueber die physiologische WirTcung des Chinin, Berlin, -1875, 
p. 89, pamphlet. 

Karamitsas, Georges. Bull. Gen. de TJierap., August 15 and 30, 1880. SurVhcema- 
turie provoquee par le quinine. 

Kerner, Dr. G. Archiv f d. ges. Physiologic, etc., Band vii, p. 122. Ueber den Ein- 



ALKALIES. 187 

Jlicss des kristallischen und des amorphen Chinins auf die weissen Blutkoiperchen. Also, 
Beitrage zur Kenntniss der Chininresorption. Ibid., 1870, p. 366. 

Kohler, Dr. H. Quoted by Virchow und HirsclCs Jahresbericht for 18*76, vol. i. 
Ueber die Wirkungen des Chinin. 

Lewizky, Dr. P. Virchow'* s Archiv, Band xlviii, p. 352. Vcber den Einfuss des 
Schwefelsauren Chinins auf die Temperatur und Blutcirculation. 

Lieberheister, Dr. C. Archiv fur klin. Med., iii, pp. 21, 569. Ueber die antipyre- 
tische Wirkung das Chinins. Also, Handbuch der Path, und Therap. des Fiebcrs, p. 654. 

Martin, Dr. Adolph. Das Chinin ah Antiphlogisticum, Giessen, 1868. 

Pantelejeff, Dr. S. London Medical Record, October 15, 18S0. On the Antagonism 
of Quinia and Morphia. 

Papow, Dr. Virchow und Hirscli's Jahresbericht, 1876, vol. i. Kritische und experi- 
mentelle Untersuchungen zur Theorie der temper aturherabsetzenden Wirkung des Chinins. 

Ransone, Dr. R. Ueber einige Beziehungen des Chinin zum Blute, 1871. Diss. 
Bonn. 

Renzi, Dr. Bull. Gen. de Therapeutique, vol. xci, p. 45. Observations sicr V elimina- 
tion du sulfate de quinine par Vurine. 

Ringer, Dr. Sydney. Various papers in the London Lancet, British Medical, and 
Journal of Physiology. 

Scharrenbroich, Dr. C. Berliner klinische Wochenschrifi, 16, 1872, p. 190. Das 
Chinin als Antiphlogisticum. 

Schroff, C. v. J. Mcdz. Jahrb.; Virchow und Hirsch. Beitrage zur Kenntniss der Chi- 
ninwirkung. 

Schtschepotjatv, Nic. Archiv f. d. gesammte Phys., xix, p. 52. Virchow und Hirsch" s 
Jahresbericht, 1878, vol. i. Selbstandige Contraction der Herzsputze, Verdnderungen der 
Muskeln und der loeissen Blutkbrperchen unter den Einfuss von Chinin. 

Schulte, Dr. A. Diss. Bei'olini, Virchow und Hirsch" 1 s Jahresbericht, vol. i, IS 71, 
p. 349. 

Schtvalbe, Dr. C. Deutsche Klinik, 36, 325, 1868. Ueber die Entzundungswidrige 
Wirkung des Chinin. 

Strassburg, Dr. Gustav. Archiv fur experimentelle Pathologie und Pharmacologic, 
Band ii, p. 334. Ueber die Ausscheidung der Kohlensaure nach Aufnahme von Chinin. 



AGENTS PROMOTING DESTRUCTIVE METAMORPHO- 
SIS OR INCREASING WASTE. 

ALKALIES. 

Potassium. — Prepaeatioxs : Potassa. — Potassa ; potasse, Fr. ; 
Kali hydricum, Ger. Caustic potash. Occurs in cylindrical rods, is 
very deliquescent, and dissolves in water and in alcohol. 

Potassii Acetas. — Acetate of potassium. A white deliquescent salt, 
wholly soluble in water (100 in 35) and in alcohol (proof spirit 1 in 2). 
Dose, grs. v — 3]. 

Potassii Bicarbonas. — Bicarbonate of potassium. In white crys- 
tals, permanent in the air, wholly soluble in water (1 in 3), and having 
a slightly alkaline taste. Dose, grs. v — 3j. 

Potassii Carbonas. — Carbonate of potassium. A deliquescent salt, 
wholly soluble in water (100 in 75). Dose, grs. ij — grs. x. 



188 AGENTS INCREASING WASTE. 

Liquor Potassii Citratis. — Solution of citrate of potassium. Dose, 

3j-!j. 

Potassii Citras. — Citrate of potassium. A whitish, granular, deli- 
quescent salt, wholly soluble in water (10 in 6). Dose, grs. v — 3 ss. 

Potassii Tartras. — Tartrate of potassium. In white crystals, which 
are somewhat deliquescent, and are wholly and readily soluble in four 
parts of boiling water. Dose, grs. v — 3j. 

Potassii et Sodii Tartras. — Tartrate of potassium and sodium — 
Rochelle salt. In colorless, transparent crystals, which effloresce 
slightly in dry air, and are wholly and readily soluble in five times 
their weight of boiling water. Soluble in cold water, 1 in 2. 

Liquor Potasses. — Solution of potassa. A colorless liquid, having 
an extremely acrid taste, and a strong alkaline reaction. Dose, hi ij 
— nx xx. It should be taken well diluted with water. 

Potassii Chloras. — Chlorate of potassium. In colorless, tabular 
crystals, which have a pearly luster, and are wholly soluble in distilled 
water (in cold water, 1 in 16*5 ; in boiling water, 1 in 2). Dose, grs. 
v— 3j. 

Trochisci Potassii Chloratis. — Chlorate of potash troches. 

Potassii JSfitras. — Nitrate of potassium. In colorless, prismatic 
crystals, unalterable in the air, and wholly soluble in water (in cold 
water, 1 in 4 ; in boiling water, 1 in 2-J). Dose, grs. ij — grs. x. 

Potassii Bicliromas. — Bichromate of potassium. In orange-red, 
anhydrous, tabular crystals, soluble in ten parts of cold, and in much 
less of boiling water, forming a solution having an acid reaction. Dose, 
gr. i— gr. ss. 

Potassii Bitartras. — Bitartrate of potassium ; cream of tartar. 
Is sparingly dissolved in cold water (1 in 210), more freely in boiling 
water (1 in 18). Dose, 3 j — J ss. 

Antagonists and Incompatibles. — The alkalies and their carbon- 
ates are incompatible with the acids and with metallic salts. The 
caustic alkalies decompose the alkaloids of belladonna, stramonium, 
hyoscyamus, duboisia, etc. In case of poisoning, the antidotes to be 
employed are — acetic, citric, or tartaric acids, in the form of vinegar, 
cider, lemon- juice, etc. Demulcents and the fixed oils limit the cor- 
rosive action of the caustic alkalies, and should therefore be given 
freely. 

Synergists. — The alkalies assist each other's action. All agents 
promoting waste — for example, mercury, the iodides, etc. — increase 
the therapeutical activity of the alkalies. 

Physiological Actions of the Potash Salts. — The most recent 
experiments having shown that potash has quite distinct properties 
from the other alkalies of the group, each member of the group is con- 
sidered separately. As an alkali, potash combines with acids to form 
salts, and with fats to form soaps. As it has a great affinity for moist- 



ALKALIES. 189 

lire, and dissolves albumen, and is a very diffusible substance, it exerts 
a destructive action on the animal tissues. These chemical facts ex- 
plain the active caustic properties of potassa f usa. In the stomach the 
salts of potash obey chemical laws, neutralize the free acid, and sapon- 
ify oily or fatty matters. Given when the stomach is empty, potash, 
as do the alkalies in general, promotes the acidity of the gastric juice, 
by increasing the diffusion of those constituents of the blood from 
which the acid of the stomach is elaborated ; but, as a large amount 
of alkali will neutralize a corresponding proportion of acid, it is obvi- 
ous that, to obtain an increased quantity of acid gastric juice, the 
amount of alkali administered must be small and rightly timed. 

When a toxic dose of potassa, of the carbonate, nitrate, or chlorate, 
is taken, violent local inflammation results. The action and the ap- 
pearances are somewhat different as regards potassa and its salts. 
The former liquefies the tissues, and extends its escharotic action 
widely and deeply, the sloughs being surrounded by a zone of inflam- 
mation. The salts, according to their activity and the quantity taken, 
set up a high degree of inflammation, cause intense burning pain about 
the epigastrium, nausea, vomiting, sometimes of bloody mucus, purg- 
ing, the stools being watery and profuse, or they may be dysenteric. 
In the case of caustic potash, marks of corrosive action, sloughs of the 
mucous membrane, bloody oozing, may be seen about the lips, mouth, 
and fauces, and shreds of bloody and sloughing tissues vomited. In 
case of toxic action of potassa and its salts, the local destruction, pain, 
and inflammation are accompanied by the usu^l systemic symptoms — 
great depression of the powers of life, a weak, rapid pulse, shrunken 
countenance, cold surface, followed by coma and insensibility. In a 
small proportion of cases the local mischief is not great, but the effects 
of the poison are expended on the nervous system, and assume the 
form of muscular weakness, paralysis of the inferior extremities, weak 
action of the heart, and coma, and a very large dose may cause death 
suddenly by paralysis of the heart before the local inflammation has 
time to develop. The nitrate and chlorate are the most active of the 
salts, but all potash bases have more or less power in the same direc- 
tion. The well-known case of Dr. Fountain, of Iowa, illustrates some 
points in the action of chlorate of potassa. Entertaining some theo- 
retical notion of the curative power of this remedy when administered 
in considerable doses, he took an ounce to demonstrate its innocuous- 
ness. Violent gastro-enteritis was produced ; at first there was free 
diuresis, but urinary suppression followed, and death ensued in seven 
days after the ingestion of the poison. When recovery takes place 
after poisoning by caustic potash, deformity of the mouth, stenoses of 
the oesophagus, cardia and pylorus, may remain, and then, after a par- 
tial improvement, the mechanical interference with the functions of 
these organs causes a more or less rapid marasmus. 



190 AGENTS INCREASING WASTE. 

When the alkaline bicarbonates are taken on an empty stomach 
they diffuse quickly into the blood, where, meeting the neutral phos- 
phate of sodium, they are decomposed, acid phosphate of sodium being 
formed, and this compound, diffusing out of the blood into the urine, 
increases the acidity of that excretion (Rolfe). The result is different 
when bicarbonate of potassium is taken during digestion, for then, the 
reaction of the gastric juice being strongly acid, this salt is decomposed, 
carbonic acid is given off, and the alkaline base lessens the acidity of 
the stomach, increases the alkalinity of the blood, and diminishes the 
acidity of the urine. The salts of potash formed with vegetable acids 
undergo conversion into alkaline carbonates in their passage through 
the organism, and are eliminated in this form, thus causing an alkaline 
condition of the urine. The period of administration unquestionably 
influences the result to a large degree, as has just been stated. The 
increased alkalinity of the blood, produced by the administration of 
the potash salts, promotes its oxidizing function (Buchheim, Basham, 
Kohler, and others). The relative quantity of uric acid is diminished, 
and of urea increased. Basham, instructed by the observations of 
Schunck, that oxal urate of ammonia is a product of the oxidation of 
uric acid, and that the former is readily converted into urea and oxalic 
acid, holds that the same process takes place in the organism when 
uric acid is subjected to the action of the potash salts. The urine of 
patients suffering from uric-acid deposits was carefully examined 
after a course of the citrate or carbonate of potassium, and it was 
found, after an interval, of about three days, that the urea was in one 
case trebled in amount, and in others more than doubled, while the uric 
acid was reduced to a fractional part of what had existed (Basham). 
The facts, then, are conclusive in regard to the increase in the oxida- 
tion processes, caused by the administration of potash, and its salts 
formed by combination with carbonic and the vegetable acids. The 
changes in the fatty constituents of the blood consist, probably, in a 
process of saponification and excretion. Nitrate and chlorate of po- 
tassium produce very different effects on the blood. Not parting with 
their oxygen in the system, and excreted undecomposed, the effects 
noted in the blood must be due to their action as a whole. The 
changes made by the chlorate in the composition of the blood have 
been studied recently by Marchand, in cases of poisoning in man and 
by experiments on animals. The blood assumes a dark, brownish, or 
chocolate color, and can no longer take up oxygen ; the haemoglobin 
is decomposed, and the injured blood-corpuscles accumulate in the 
spleen ; the kidneys are brownish in color, and the tubules are choked 
with the broken-down materials of the red globules. The peculiar 
brownish color of the blood is found, by spectroscopic analysis, to 
be due to a substance identical with Hoppe-Seyler's methsemoglobin. 
These effects separate the chlorate, nitrate, and other compounds of 



ALKALIES. 191 

potassa very distinctly from the compounds with vegetable acids, 
while the latter also differ distinctly from the former in the power to 
alkalinize the blood and urine. 

Avery considerable reduction of temperature is produced by large 
doses of the potash salts (Podcopaew, Guttmann, Traube). This effect, 
due especially to chlorate and nitrate of potassium, may be readily ex- 
plained by the changes in the haemoglobin, which impair its function 
as a carrier of oxygen. Ordinary doses do not affect temperature de- 
cidedly, probably because they do not have the power to change the 
properties of haemoglobin. The alterations produced in the composi- 
tion of the blood by the salts of potash necessarily affect the nutritive 
functions. The increased elimination of urea, the waste of the fatty 
constituents of the blood and of the tissues, the more rapid process of 
oxidation, results of the action of the potash salts, necessarily place 
these remedies among the list of those promoting destructive meta- 
morphosis. 

Drs. Ringer and Murrell find chloride of potassium to be a proto- 
plasmic poison, and to this effect they refer its action on the brain and 
nervous system and on the heart. That potash is a poison to the heart 
has long been known. The experiments of Podcopaew, repeated sub- 
sequently by Guttmann, confirm this. Whether introduced directly 
into the circulation, by injection into the jugular vein or subcutane- 
ously, the paralysis of the heart follows — more speedily, when the 
poison reaches the heart more directly. The arrest of the heart takes 
place in the diastole, and occurs after division of the pneumogastric, 
whence it must be concluded that the effect on the heart is not exerted 
through increase of the inhibition. As, when a large dose is suddenly 
precipitated on the heart, its movements are speedily arrested, and the 
muscle of the beart does not then respond to electrical excitation, the 
effects of the poison must be expended chiefly on the muscular tissue 
(Traube), but not wholly so, since, before the electro-contractility is 
entirely abolished, all motion may be arrested. The cardiac ganglia 
must therefore participate in the changes wrought by the poison. The 
effect of potash on the tension of the vessels — on the blood-pressure — 
is much influenced by the quantity and mode of administration. A 
large quantity by intra-venous injection quickly poisons the heart and 
lowers the pressure in the arterial system. On the other hand, small 
doses increase the tension (Hummel, Traube). As elimination takes 
place very rapidly, it is not surprising to find that the normal pressure 
is quickly restored. This difference in the result, due to the size of 
the dose, is largely responsible for the conflicting statements which 
have been put forward. 

It has been ascertained by Ringer and Murrell, and by Guttmann, 
that the contractility of the muscles and the irritability of the motor 
nerves persist after complete paralysis induced by the potash salts. 



192 AGENTS INCREASING WASTE. 

The paralyzing action must, therefore, be exerted on the spinal cord. 
In fact, as Ringer and Murrell have shown; potash, being a protoplas- 
mic poison, affects most injuriously the most highly specialized struc- 
tures ; hence the brain and spinal cord suffer earlier and more severely 
than do other tissues. Valentin has made some very interesting com- 
parative observations on the effects of the chlorides of the alkalies, 
when frogs are immersed in solutions of these salts. In a ten-per-cent 
solution of chloride of ammonium, the frogs died in two or three min- 
utes ; in the chloride of potassium and lithium solution of the same 
strength, death occurred in ten minutes ; in chloride of sodium solu- 
tion, in ten to twenty-five minutes ; and in chlorides of calcium and 
barium solutions, also of the same strength, death ensued in the course 
of thirty minutes. Besides the cutaneous irritation, the effects were 
similar to those already mentioned, except the changes in nerve and 
muscle reactions, the result, doubtless, of imbibition. The early sus- 
pension of the reflexes, the fibrillary trembling of the muscles, and 
the loss of electro-contractility almost at once, indicate the local action 
of the poison. 

The elimination of the potash salts takes place by various channels, 
chiefly by the kidneys, but they also appear in the saliva, sweat, milk, 
and other secretions. The effect of these salts on the reaction of the 
urine and the differences in result due to the period of administration 
have been pointed out. The state of acidity of the stomach greatly 
affects the reactions of the urine produced by the carbonates of po- 
tassa (Ralfe). The salts of vegetable acids undergo decomposition in 
their passage through the system ; they render the urine alkaline, and 
greatly increase the excretion of free carbonic acid (Parkes). The 
after-condition of the urine is that of increased acidity (Ralfe). The 
nitrate and chlorate of potassa are eliminated unchanged, and do not 
affect the reaction of the urine (Laborde). The notion entertained in 
some quarters that chlorate of potassa parts with its oxygen, is en- 
tirely erroneous. These salts increase the amount of urinary water, 
and, in common with the other members of the family, promote oxi- 
dation and the excretion of urea. While the acetate increases the 
discharge of urinary water, it actually lessens the quantity of solids 
excreted (Parkes). The production of saliva is much increased by the 
chlorate, which is freely eliminated by the salivary glands (Laborde). 
It is a very important fact, which we owe to Dr. Jacobi, of New York, 
that chlorate of potassa irritates the kidneys, and if continued a suffi- 
cient time sets up a chronic nephritis. Others have made similar ob- 
servations, so that the popular use of this supposed harmless agent 
should be discouraged by the -medical profession. 

Therapy of the Potash Salts. — Chlorate of potash is in almost 
universal use as a remedy for catarrhal inflammation of the mouth 
and fauces, for acute tonsillitis, aphthous ulcerations of the mouth, 



ALKALIES. 193 

stomatitis mate-ma, or nursing sore mouth, and mercurial stomatitis. 
As above stated, the domestic use of this remedy for sore mouth and 
sore throat has become an evil which should be discouraged. For or- 
dinary purposes this remedy should not be employed. The utility of 
the chlorate is, however, so decided in the case of stomatitis materna, 
that all other considerations are merely secondary. In this malady 
large doses (fifteen grains to 3 j three or four times a day) are neces- 
sary, and a less amount will fail to effect a cure. In mercurial stoma- 
titis, ulcerative tonsillitis, diphtheritic angina, etc., the following for- 
mula may be applied locally : I£ Potassii chlorat., 3 j ; acid, carbolic, 
3 ss ; glycerini, § j ; aquae, § iij. M. Sig. : Lotion. 

The potash salts are used with great advantage in many stomach- 
disorders. It is an undoubted chemical fact that an excess of acid is 
relieved by an alkali, but the result is not permanent, and the cause of 
the acidity is not removed. Small doses of an alkali, given with a 
bitter before meals, promote the flow of gastric juice, and are a ser- 
viceable combination in atonic dyspepsia. ~fy Inf. calumbse, § iv ; 
liq. potassae, 3 ss. M. Sig. : A dessert to a tablespoonf ul three times 
a day before meals. Administered after meals, the alkalies will relieve 
the acidity due to an excessive production of acid, or to the acid fer- 
mentation of the starch, sugar, and fat, in the food. An acid given 
before meals is the proper remedy for the excessive formation of the 
acid of the gastric juice. Alkalies render an important service in case 
of indigestion of fats. Not only do they prevent the formation of 
butyric acid, but they assist in the process of emulsionizing the fats 
and help their absorption. In diseases of the liver, and when from 
any cause the flow of bile into the intestine is prevented, alkalies assist 
in the digestion and absorption of fats. The indigestion of obese sub- 
jects, and of the gouty and rheumatic, is usually cured or alleviated 
by alkalies. The lithia salts are generally to be preferred in gouty 
and rheumatic subjects ; but, generally speaking, the bicarbonate of 
potassium is the most useful of the alkali remedies in the above-men- 
tioned maladies. 

The salts of the alkalies, especially the citrates, tartrates, and car- 
bonates of potassium, are useful in inflammatory diseases to lessen heat, 
and to promote excretion of the products of inflammation. When 
oxidation is deficient, as represented in an excess of uric acid in the 
urine, a coated tongue, hebetude of mind — the so-called " bilious state " 
— relief is afforded by the use of the alkalies and their laxative salts. 
The alkaline treatment of acute rheumatism is based on these prin- 
ciples. Although this plan of treatment may not be adapted to all 
cases, there can be no doubt of its utility in respect to a considerable 
proportion. It must be borne in mind, as Dr. Fuller, the most influ- 
ential advocate of the method, informs us, that the alkaline treatment 
consists in a plan, made up in part of the use of bicarbonate of potas- 
13 



194 AGENTS INCREASING WASTE. 

sium, and in part of certain adjuvants, notably quinine. The main 
point in the treatment consists in the administration of remedies to 
induce an alkalinization of the system as quickly as possible, for when 
this is accomplished further joint and heart complications are not like- 
ly to occur. Fuller gives not less than an ounce and a half of bicarbon- 
ate of potassium, largely diluted with water, in the first twenty-four 
hours of the treatment. Sometimes this salt is given in effervescence 
with lemon-juice — in the proportion of two drachms to an ounce of 
lemon-juice — every three or four hours, or with citric-acid solution. If 
the bowels are torpid, one or more compound cathartic pills are pre- 
scribed in addition. As soon as the urine ceases to exhibit an acid 
reaction — usually at the expiration of twenty-four hours — the quantity 
of potassic carbonate is reduced one half. If the urine continues alka- 
line at the expiration of another period of twenty-four hours, the alkali 
is further reduced one half, and, on the fourth day, the same conditions 
continuing, the treatment ceases to be exclusively alkaline. Then the 
alkali is reduced to the amount necessary merely to keep the urine 
neutral — about a half -drachm of the bicarbonate three times a day, 
and quinine is given. In Dr. Fuller's words, three grains of quinine, dis- 
solved in lemon-juice, is given three times a day in effervescence with 
half a drachm of bicarbonate of potash. In ninety-four cases of acute 
rheumatism thus treated, the average duration, from the beginning of 
treatment, was eleven days. This method is adapted to the treat- 
ment of the plethoric, obese, and muscular subjects, and in the experi- 
ence of the author is not well suited to the pale, delicate, and anaemic 
rheumatic. 

In irritation of the urinary organs due to an excess of acid, the 
combinations of potash with the vegetable acids possess a high degree 
of utility. The liquor potassae is much prescribed under these circum- 
stances, but, as it is very irritating to the stomach, the salts are prefer- 
able, and they are equally effective. The liquor potassii citratis is an 
excellent form for this purpose. There is no doubt that the long-con- 
tinued use of alkalies (citrate, acetate, and carbonate of potassa) will 
effect the solution of renal calculi, which are usually composed of uric 
acid. As the urate of soda is often the nucleus of these formations, the 
soda alkalies should not be used. Small doses taken daily for length- 
ened periods are necessary. Such alkaline waters as the Vichy may 
be used if more agreeable to the patient, but the best results are ob- 
tained by the administration of the citrates and tartrates in a large 
quantity of distilled water. When the urine is acid in any of the forms 
of cystic irritation — from stone, cystitis, stricture, enlarged prostate, 
etc. — great relief is experienced from the use of alkalies, notably the 
liquor potassae, the citrates, acetates, and carbonates of potassium. 
When the urine is alkaline in reaction, no benefit can be derived from 
the use of .these remedies. 



ALKALIES. 195 

The bitartrate and the acetate of potassium are very certain diu- 
retics, especially the first named. They are most effective when given 
largely diluted with water. A pleasant form in which to administer 
cream of tartar is the familiar " cream-of -tartar lemonade," made as 
follows : A sufficient quantity of the remedy is dissolved in hot water ; 
when cold the clear solution is poured off ; some lemons are cut up and 
put in it, and it is sweetened to the taste. This solution may be drunk 
ad libitum, Considerable stomach and intestinal distress often follows 
the free use of dilute solutions of these potash salts, in consequence of 
the abundant production of carbonic-acid gas. The potash salts are 
indicated as diuretics in desquamative nephritis, and in general dropsy 
from valvular disease of the heart. By determining a free urinary 
discharge in the one case, they assist in washing out the obstructing 
epithelium in the tubules ; in the other, they relieve the tension of the 
venous system. Very little is accomplished by the use of alkaline 
diuretics in dropsical accumulations in the various cavities. 

Sodium. — Soda. — Soda ; Natrium, Ger. ; sonde, Fr. Occurs in ir- 
regular flat masses. Is soluble in water and in alcohol. 

Liquor Sodce. — Solution of soda. A colorless liquid, having an ex- 
tremely acrid taste, and a strong alkaline reaction. Dose, tti ij — v\ x. 

JSodii Acetas. — Acetate of sodium. In white or colorless crystals, 
which effloresce in dry air, and are wholly soluble in water. Dose, 
grs. v— 3 j. 

JSodii Bicarbonas. — Bicarbonate of sodium. A white, opaque pow- 
der, wholly soluble in water (1 in 12). Dose, grs. v — 3 j. 

JSodii Boras. — Borate of sodium. Borax. In colorless crystals, 
which slightly effloresce in dry air, and are wholly soluble in water. 
Dose, grs. ij— 3j. 

JSodii Carbonas Exsiccatus. — Dried carbonate of sodium. A white, 
hygroscopic powder, having the same properties as the carbonate. 
Dose, grs. ij — grs. x. 

JSodii Carbonas. — Carbonate of sodium. " Large, monoclinic crys- 
tals, rapidly efflorescing in dry air and falling into a white powder ; 
alkaline taste and reaction." Soluble in 1*6 water at 60° Fahr., and 
nearly twice as soluble in hot water. Dose, grs. v — 3 j. 

JSodii Nitras. — Nitrate of sodium. Colorless, transparent, rhombo- 
hedral crystals, slightly deliquescent in damp air, having a cooling, 
slightly bitter taste, and a neutral reaction. Soluble in 1*3 water at 
60° Fahr., and in 0*6 boiling water. Dose, 3 j — 1 j. 

Sodii Sutyhas.— Sulphate of sodium. Glauber's salts. Dose, f ss 

-5J. 

Pidveres Effervescentes. — Effervescing powders. Each powder con- 
tains thirty grains of bicarbonate of sodium in one paper, and twenty- 
five grains of tartaric acid in the other paper. (Not official.) 



196 AGENTS INCREASING WASTE. 

Pulvis Effervescens Compositus. — Compound effervescing powder. 
Seidlitz powder. Each powder contains forty grains of bicarbonate 
of sodium and one hundred and twenty grains of tartrate of potassium 
and sodium (Rochelle salt) in one paper, and thirty-five grains of tar- 
taric acid in the other paper. 

Antagonists, Incompatibles, and Synergists, are the same as 
those given under potassium. 

Physiological Actions of the Salts of Sodium. — In respect 
to the merely alkaline properties, there is a close correspondence be- 
tween potassium and sodium, but as regards other properties there is 
a wide divergence. The salts of soda are alkaline, and hence neutral- 
ize the acid of the gastric juice. They are readily diffusible. Like 
the potash salts, they increase the alkalinity of the blood, and under 
suitable conditions determine a change in the urine from acid to alka- 
line. The same results follow the administration during or between 
the intervals of digestion, as in the case of the potash salts. The alka- 
linity of the urine induced by soda salts ceases on the day following 
their administration, and the acidity is then increased. Soda has but 
little toxic action besides the local caustic effects. Caustic soda, like 
caustic potash, dissolves albumen, forms soaps with fats, and destroys 
the tissues widely and deeply. It is, however, less active than caustic 
potash. The composition of the blood does not appear to be altered 
by the salts of soda in any reasonable quantity. Laborde, in some 
comparative experiments between chlorate of potassa and chlorate of 
soda, finds that the latter, in treble the quantity of the former, has but 
a transient effect, depressing the temperature half a degree, and caus- 
ing a slight salivation, but producing none of the paralytic symptoms 
which follow the administration of the potash salts. Guttmann had 
previously demonstrated the same facts, and Schonlein, in some stud- 
ies with the carbonate, finds that even in large doses in frogs it rarely 
arrests the heart's movements, only slowing and lengthening the con- 
tractions. Chloride of sodium has, unquestionably, an important office 
in the economy. It forms the principal part of the soluble constitu- 
ents of the ash of all animal substances. Albumen owes its solubil- 
ity in part to the chloride of sodium ; it dissolves pure casein, and 
impedes the coagulation of the fibrin of the blood. In one thousand 
parts of blood there are about four parts of this salt. It is very abun- 
dant in various normal secretions and pathological products. The 
gastric juice is very rich in chloride of sodium, and it probably is the 
source of the hydrochloric acid of the stomach (Lehmann). In the 
course of an inflammation, notably of pneumonia, the chloride of so- 
dium of the system accumulates in the inflamed area, and disappears 
from the urine. Its return to the urine is in the nature of a critical 
phenomenon, and marks the subsidence of the inflammation. The im- 
portance of this salt in the animal economy is doubtless the cause of 



ALKALIES. 197 

the universal taste ; all in excess of the needs of the body is excreted, 
chiefly by the kidneys, and with such facility that no accumulation 
takes place. While a necessary amount is of high importance and 
excess is readily disposed of, it is probable that long and habitual in- 
dulgence in a considerable excess increases waste and lowers the vital 
forces. 

Therapy of Sodium Salts. — One of the important salts of soda — 
the phosphate — has been considered under the head of phosphates. 
The soda salts are to be preferred in the alkaline treatment of stomach- 
diseases, but the potash salts when it is desired to promote oxidation 
in the system, or to alkalinize the urine. The urate of soda is insol- 
uble. In case of excess of acid or acid indigestion, the use of soda 
after meals is very effective ; but, while the immediate result is good, 
the after-effect is to increase the production of acid. Those who 
habitually take sodium bicarbonate for acid indigestion suffer severely 
from acidity. Taken before meals, or on an empty stomach, soda 
bicarbonate is useful in atonic dyspepsia, to increase the acid of the 
gastric juice. Acute indigestion, with vomiting, especially if the vom- 
ited matters are very acid, and there is burning at the epigastrium, may 
be quickly relieved by the effervescing powder. The acid diarrhoea 
of children is relieved by the bicarbonate of sodium. This salt may be 
utilized as an emetic in narcotic stupor when other emetics fail to act. 
The author has known this method to succeed in opium narcosis. A 
half to a drachm of bicarbonate in solution in water is swallowed or 
thrown into the stomach by the pump, and this is followed imme- 
diately by a similar quantity of tartaric acid. Brisk effervescence 
ensues, and the contents of the stomach are evacuated. In intussus- 
ception, the same expedient has been practiced with success. The 
solution of bicarbonate of sodium is thrown into the rectum, and is 
followed by the acid. Strong pressure must be made on the anus ; the 
gas forces the bowel back through the ileo-csecal valve and thus re- 
lieves. A stomach or bowel much softened by inflammation, or weak- 
ened by ulceration, is a contraindication of such an expedient. 

In the treatment of the febrile state, and to lessen the acidity of 
the urine, the soda salts have been proposed as substitutes for the pot- 
ash salts. The researches of Laborde, Guttmann, Podcopaew, and 
others, have shown that the former do not have the same powers as 
the latter, and that therefore the substitution can not be made suc- 
cessfully. 

Calcium. — Calx. — Lime ; Kalk, Ger. ; chaux, Fr. 
Calcii Carbonas Prcecipitatus. — Precipitated carbonate of calcium. 
A fine, white powder, insoluble in water. Dose, grs. v — 3 j. 
Creta Prceparata. — Prepared chalk. Dose, grs. v — 3 j. 
Liquor Calcis. — Lime-water. 



198 AGENTS INCREASING WASTE. 

Liquor Calcis Saccharatus. — Dose, 3 ss — 3 ij (unofficial). 

Testa Prmparata. — Prepared oyster-shell. Dose, grs. v — 3 j (un- 
official). 

Mistura Cretce. — Chalk-mixture. Dose, 3 j — § ss. 

Syrupus Calcis. — Sirup of lime (lime 5 parts to 100 sirup). Dose, 
a teaspoonful or more. 

Calcii Chloridum. — A colorless or whitish salt, sometimes trans- 
lucent, very deliquescent. It is soluble in two parts of water, and 
also in alcohol. Dose, grs. v — 3j, and is preferably administered in 
milk. This should not be confounded with chlorinated lime. (Other 
salts of calcium are included under phosphates, hypophosphites, sul- 
phides, and bromides.) 

Antagonists and Incompatibles, and Synergists, the same as 
for potassium. 

Physiological Effects of Calcium Salts. — The important po- 
sition of phosphate of lime in the organism has been already set forth 
under the appropriate head. It is only necessary to state in this con- 
nection that the lime salts are antacid, or alkaline, and as such they 
neutralize the acid of the gastric juice. They act locally as sedatives 
to the mucous membrane. Some of them have a local action merely, 
but the chloride is very diffusible, and the carbonate feebly so. En- 
tering the blood in small quantity, they promote constructive meta- 
morphosis ; but the habitual use of large quantities hastens waste, or 
the retrograde metamorphosis of the tissues. 

Administered in the ordinary way, however, the lime salts furnish 
materials needed by the organism in its growth. The carbonate of 
lime is taken up in limited quantity by the stomach-juices and re-en- 
forces the same constituent in the blood. The chloride of calcium has 
a different office in the economy. It acts in a similar manner to the 
other chlorides, and has close relationship to the iodides. Clinical 
experience has shown that it possesses the ill-defined property known 
as alterative, removes certain toxic or morbific materials, and secures 
their excretion by the organs of elimination. The recent studies of 
the therapeutical actions of chloride of calcium have shown it to pos- 
sess the remarkable property of an antagonist or antidote to the stru- 
mous constitution. No mere physiological investigation could have 
demonstrated this power ; it is an empirical fact which we can not 
explain as yet by physiological methods. It has been shown, how- 
ever, that under its use enlarged and cheesy lymphatics gradually 
resume their normal condition, tubercular deposits undergo a process 
of calcification, and ulcerating cavities discharge their contents and 
cicatrize. It can not, of course, be asserted that such surprising 
changes frequently occur, but, that they do sometimes take place, 
clinical experience has proved. From this point of view, then, chlo- 
ride of calcium assumes a high degree of importance. 



ALKALIES. 199 

Therapy of the Calcium Salts. — No remedy is more frequently 
prescribed for vomiting than lime-water. It is given very often with 
milk, one half, one fourth, as may be, and the combination is effective 
in arresting vomiting due to acute troubles of the abdominal organs, 
and also useful in vomiting of cerebral and reflex origin. When the 
milk-cure is prescribed, lime-water is frequently added to enhance the 
digestibility of the milk. Carbonate of lime is a useful restorative 
and antacid in the acid indigestion, and in the diarrhoea of strumous 
children. By Dr. Warburton Begbie and by Dr. Coghill the chloride 
of calcium is strongly urged, as the most efficient remedy in the feeble 
digestion and disordered secretions of strumous children. The latter 
especially commends the use of the chloride in " children when the 
sleep becomes restless and troubled, the breath fetid, the tongue foul 
and coated, the tonsils enlarged, the evacuations irregular and offen- 
sive, with deficient secretion of bile." In the colliquative diarrhoea 
of the strumous, it is said to be curative, even when accompanied by 
enlargement of the mesenteric glands. According to the published 
observations of Begbie, Coghill, and Bell, we possess no agent so val- 
uable in the wasting diseases of children of strumous origin, in glan- 
dular enlargements, etc. The testimony which has been lately pub- 
lished in respect to the curative power of chloride of calcium in 
consumption is certainly very striking, and especially in those cases 
succeeding to glandular enlargements heretofore so little amenable 
to treatment. According to Rodolfe, chloride of calcium cures chorea 
speedily. 

Lithium. — Lithium. 

Lithii Carbonas. — Carbonate of lithium. A white powder, spar- 
ingly soluble in water (1 in 100), and having a feeble alkaline reaction. 
Dose, grs. ij — grs. x. 

IAthii Citras. — Citrate of lithium. A white powder, deliquescent 
and soluble in twenty-five parts of water. 

Lithii Salicylas. — Salicylate of lithium. A white powder, deli- 
quescent on exposure to air, having a sweetish taste and a faintly acid 
reaction. It is freely soluble in water and in alcohol. Dose, gr. v — 3 j. 

Lithii Benzoas. — Benzoate of lithium. A white powder, or small 
shining scales, permanent in the air, having a cooling, sweetish taste 
and a faintly acid reaction. Soluble in four parts of water and twelve 
parts of alcohol at 60° Fahr. Dose, gr. ij — gr. xv. 

Antagonists and Incompatlbles, and Synergists, are the same 
as for the other alkalies. 

Physiological Actions of the Lithium Salts. — These remedies 
have strong alkaline and basic properties, and act on the organism of 
man in the same manner as the other members of the group. The 
compound of uric acid and lithium is readily soluble, differing in this 



200 AGENTS INCREASING WASTE. 

respect from the urate of soda. It is said that the lithium salts alka- 
linize the urine more decidedly than even the potash salts. 

Therapy of the Lithium Salts. — Garrod first introduced these 
remedies into medical practice for the treatment of rheumatism, and 
in his recent Lumleian lectures has demonstrated anew their excep- 
tional value. Recently the compound of lithium and salicylic acid has 
been brought forward as a more effective remedy in the rheumatic 
diseases. The subacute and chronic cases, and the so-called rheitmatic 
gout, are the forms of the disease in which the lithium salts are most 
serviceable. In the so-called uric-acid diathesis, in renal calculi com- 
posed of uric acid, and in irritable bladder from an excess of acid in 
the urine, the salts of lithium are useful. In the case of a renal cal- 
culus a very protracted use of a well-diluted solution is necessary. 

External Applications of the Alkalies. — A solution of com- 
mon soda (impure bicarbonate) freely applied will often remove the 
fetid sweat of the feet, and the odorous emanations ichich in some 
subjects escape from, the axillary glands. Acne occurring in persons 
with a greasy skin, and prominent and black sebaceous follicles, may 
sometimes be cured by alkaline lotions. J> Liq. potassae, 3 j ; aquae 
rosae, § iv. M. Sig. : Apply with a soft sponge twice a day. For 
acute eczema where there is much serous discharge, no applications are 
more efficient than solutions of the alkalies. I£ Sodii carbonat., 3 ss ; 
aquae, Oj. M. Sig. : The eruption to be covered with lint soaked in 
this solution. Stronger solutions can be used in old cases where the 
skin is much thickened. As alkalies, by absorbing the moisture and 
combining with the fat of the sebaceous matter, make the skin dry 
and harsh, it is useful to apply some form of oil after these alkaline 
applications, certainly after the stronger solutions. Mutton-suet is one 
of the best fats for this purpose. 

In prurigo great relief is often obtained by an alkaline warm bath 
at bedtime. A solution of carbonate of potassium ( 3 iij — § iv) is 
recommended by Trousseau as a remedy for that obstinate affection — 
pruritus vidva. In freckles, sunburn, and tan, the following lotion is 
useful: fy Potassii carbonat., 3 iij ; sodii chloridi, 3 ij ; aquae rosae, 
5 viij ; aquae aurantii nor., § ij. M. Sig. : Lotion. 

To cleanse the scalp from dandruff {pityriasis), there is no more 
suitable application than a saturated solution of borate of soda. Pow- 
dered borax, mixed with sugar, is a domestic remedy for aphthw of 
children ; it is simply placed on the tongue. A saturated solution of 
borax in rose-water is a useful application to remove freckles, and to 
allay pruritus vaginm. 

A solution of permanganate of potassa (gr. j — 3 j) is an elegant 
toilet remedy for correcting fetor of the breath. In ulcerous diseases 
of the buccal cavity it is used to destroy foul odors, and to improve the 
condition of the sloughing surface. In ill-conditioned wounds gener- 



ALKALIES. 201 

ally solutions of this salt, in various strengths, are employed with a 
view to change the action, but little more is accomplished than tem- 
porary destruction of odors. There are many other agents, much 
less expensive and more powerful, which can be used for these pur- 
poses. 

The so-called ingrowing toe-nail may be cured by the application 
to the irritable granulation, at the margin of the nail, of a solution of 
liquor potassse ( 3 ij — 1 j). This solution is to be applied on cotton- 
wool, to the margin of the nail and to the ulcerated surface of the 
toe, until the nail is so far softened that it can be cut away without 
pain. 

Unhealthy and sloughing ulcers may be destroyed by potassa fusa, 
and a healthy granulating surface be left. No more efficient escharotic 
can be used in hospital gangrene. As it penetrates deeply and widely, 
great care must be used to limit its application to the affected parts, 
and, as soon as the destruction is sufficient, to check the further exten- 
sion of the caustic by washing with a dilute acid. Vienna paste-— which 
is a mixture of equal parts of potassa and lime made into a paste with 
alcohol — is milder in operation, and therefore usually preferred. Caus- 
tic potash was formerly much employed to make issues, to open ab- 
scesses and carbuncles, but these applications are now quite obsolete. 
Induration of the cervix uteri and chronic metritis (hyperplasia of the 
connective tissue) are, it is said (Dr. Bennet), very effectively treated 
by application of caustic potassa and potassa cumcalce; but such pow- 
erful means must be used with great caution, if at all. In carcinoma, 
when the disease is limited to the neck of the uterus and not too far 
advanced, caustic potassa may be used with advantage to destroy the 
diseased surface. This caustic is quite as efficient as any, probably, 
for the escharotic treatment of cancer when this method of treatment 
is employed. 

A solution of the bichromate of potassium (gr. j — grs. x — § iv) is 
an excellent local application in the treatment of the catarrhal state of 
the nasal, buccal, or vaginal mucous membrane. A saturated solution 
of this salt may be used as a caustic in place of chromic acid. 

Carbonate of soda in saturated solution has been used lately with 
signal success in the treatment of burns: it allays the pain, checks 
suppuration, and favors healing (McClellan, Pring, etc.). Cloths 
dipped in a saturated solution, and covered with oiled silk, are kept 
on the part, the solution being renewed as rapidly as may be neces- 
sary. Dr. Duckworth reports that toothache may be quickly allayed 
by holding a solution of carbonate of soda in the mouth. Recently 
chlorate of potash has been used with success in the treatment of epi- 
thelioma. This practice was first suggested by Vidal in the treatment 
of chancroid, and has since been successfully employed in the treat- 
ment of obstinate ulcers, epithelioma and cancer (Fereol, Leveque). In 



202 AGENTS INCREASING WASTE. 

the simpler cases a saturated solution may be applied, but in epithe- 
lioma and cancer the powdered chlorate is thickly placed over the 
sore. It is said to allay pain, remove fetor, and promote cicatrization 
when so applied. The internal use of the salt is recommended in 
conjunction with the topical application in cancer, epithelioma, and 
lupus. 

Authorities referred to : 

Basham, Dr. W. R. The Practitioner, vol. v, p. 25*7. % 

Begbie, Dr. J. Warburton. The Edinburgh Medical Journal, July, 18*70, p. 46. 

Bell, Dr. Robert. The Lancet, August, 1877, p. 275. 

Binz, Dr. C. Archiv fur experiment. Pathologie und Pharmacologic, vol. x, p. 153. 
Ueber Reduction des chlorsauren Kalis. 

Buchheim, Prof. Dr. R. Archiv fur experiment. Pathol, und Pharmacol., Band iii, p. 
252. Ueber die Wirkung der Kaliumsalze. 

Coghill, Dr. J. G. Sinclair. The Practitioner, vol. xix, p. 247. Therapeutic Notes 
on the Chloride of Calcium. 

Duckworth, Dr. Dyce. TJie Practitioner, April, 1875, p. 250. 

Fuller, Dr. H. W. The Practitioner, vol. ii, p. 129. The Alkaline Method in the 
Treatment of Rheumatism. 

Guttmann, Dr. P. Virchoufs Archiv, Band xxxv, p. 450. Wirkung der Kali und 
Natronsalze. 

Hummel, Meinrad. Allg. Wiener med. Zeit., 23-26, 1878. Ueber das Kalium Chlo- 
ricum. 

Isambert, Dr. Gaz. Med. de Paris, 1874, Nos. 17, 35, 41, and 43. Nouvelles expe- 
riences sur V action physiologique, toxique et titer apeutique du chlorate depotasse. 

Kohler, Prof. Dr. H. Centralblatt f. d. med. Wiss., 1877, No. 38, p. 673. Zur 
Wirkung der Kaliumsalze auf Warmbluter. 

Laborde, Dr. J. V. Bull. Gen. de Therap., 1874, pp. 247, 319, and 354. £tude com- 
parative de V action physiologique des chlorates de potasse et de soda, etc. 

Marchand, Dr. F. Virchow's Archiv, Band lxxvii, p. 455. Ueber die Intoxication 
durch Chlorsdure Salze. 

McClellan, Dr. Ely. Louisville Medical News, 1878. On Relief of Burns by a Satu- 
rated Solution of the Carbonate of Soda. 

Parkes. On the Urine, p. 158. 

Perl, Dr. Leopold. Virchow's Archiv, vol. lxxiv, p. 54. Ueber die Resorption der 
Kalksalze. 

Podcopaew, Dr. Virchoio's Archiv, Band xxxiii, p. 505. Vergleichende Untersuchungen 
uber die Wirkung des Chlorkalium und Chlornatrium auf den thierchen Organismus. 

Pring, Dr. E. J. Philadelphia Medical Times, March 16, 1878, p. 273. Note on the 
Use of Bicarbonate of Soda in Burns. 

Rabuteau, Dr. Gazette Hebdom., xliii, 1868, p. 617. Recherches sur Velimination et 
sur proprietes osmotiques du sulfate de sodium. 

Ralfe, Dr. C. Lancet, November, 1878, p. 651. Observations in Urinary Pathology 
and Therapeutics. 

Ringer and Murrell. Journal of Physiology, vol. xii, p. 5. Influence of the Chloride 
of Potassium on the Nervous System of Frogs. 

Schonlein, K. Arch.f. d. ges. Physiol, vol. xviii, p. 26. Versuche uber einige physi- 
ologische Wirkung en des Natriumcarbonats. 

Valentin, Dr. Zeit. fur Biol, vol. xiv, p. 320. Die Giftwirkungen welche Salzbcider 
auf Frbsche ausuben. Virchow u. Hirsctts Jahresbericht. 



ALKALINE SPRINGS. 203 

ALKALINE MINERAL SPRINGS. 
1. North America. 

Bladon Springs, Choctaw County, Alabama. A rolling, pine-woods 
region. 

They contain carbonate of soda, carbonate of magnesia, carbonate 
of iron, carbonate of lime, sulphate of lime, carbonic-acid gas, sul- 
phureted hydrogen (traces), and chlorine. 

Congress Springs, Santa Clara County, California. In the Coast 
Range of mountains. 

They contain carbonate of soda (15*418 grains to the pint?), car- 
bonate of iron, carbonate of lime, chloride of sodium (14*894 grains to 
the pint), sulphate of soda, etc. They are highly charged with car- 
bonic-acid gas. 

California Seltzer Springs, Mendocino County, California. 

They Contain carbonate of soda, carbonate of magnesia, carbonate 
of lime, carbonate of iron (a trace), and chloride of sodium. They 
are also highly charged with carbonic-acid gas. 

Perry Springs, Pike County, Illinois. 

They contain carbonate of potassa, carbonate of magnesia, carbo- 
nate of iron, carbonate of lime, sulphate of soda, silicates of soda and 
potassa. Temperature of the water is from 48° to 50° Fahr. 

St. Louis Spring, Gratiot County, Michigan. 

This water contains carbonate of soda (7*684 grains to the pint), 
carbonate of magnesia, carbonate of iron, carbonate of lime (5*019 
grains to a pint), sulphate of lime (6'925 grains to a pint), silicate of 
lime, and silica. This is one of the so-called " magnetic springs " — 
the magnetic property being due not to the water, but produced by 
the magnetization with terrestrial currents of the vertical iron tube 
through which the water flows. It is unfortunate that this part of 
the peninsula of Michigan, in which the numerous alkaline and saline 
springs abound, is very decidedly malarious. 

Buffalo Lithia Spring, of Virginia. Contains well-defined traces of 
lithia, and is alkaline. This has been used with great advantage in 
gouty, rheumatic, and renal affections. 

The Hot Springs, Bath County, Virginia, contain carbonates of lime 
and magnesia, sulphates of lime, magnesia, and soda, and chlorides of 
sodium, calcium, and magnesium. The temperature of the water 
ranges from 100° to 106° Fahr. 

The Warm Springs, Bath County, Virginia, have a composition 
similar to the hot springs, but the temperature of the water is some- 
what less. At these springs, extensive bathing-pools have been con- 
structed. The best results have been obtained from the bathing, con- 
joined with the internal use of the water. 

Berkeley Springs are also situated in Bath County. The waters 



204 AGENTS INCREASING WASTE. 

are alkaline, of a constant temperature of 72° to 74° Fahr., and are 
employed by bath and internally. 

Rockbridge Baths, Rockbridge County, Virginia. A mountainous 
region. 

They contain magnesia and iron, with a small quantity of iodine. 
Temperature, 74° Fahr. Used chiefly in the form of baths. 

Capon Springs, Hampshire County, West Virginia. 

This water contains carbonate of soda, carbonate of magnesia, and 
traces of iodine and bromine. The temperature of the water is 66° 
Fahr. These springs are situated in a romantic mountain-region. 

Besides the above, there are numerous weakly-alkaline waters, such 
as Bethesda and others of the Waukesha region of Wisconsin, in South- 
ern Michigan, and in many parts of the United States. It is impos- 
sible to mention all of them, and especially to set forth the rather pre- 
tentious claims, or recognize the apocryphal cures, so persistently and 
profusely published by their owners. Unquestionably good results 
have been wrought by these waters. Besides the positive there are 
negative virtues in these numerous mineral springs : they take the 
place of the indiscriminate drug administration which is one of the 
evils of the time. 

2. European. 

Vichy, Central France. 

There are several springs — Grande Grille, Puits Carre, Hopital, 
Celestins, De Mesdames, and others. The waters contain carbonates 
of soda, of potassa, magnesia, and lime, sulphate of soda and chloride 
of sodium, phosphate of soda, arseniate of soda (a trace), carbon- 
ates of strontia and iron. The gas, which is abundant, is carbonic 
acid. 

In the Vichy region there are numerous alkaline springs having 
similar properties. The temperature of the waters varies from 58° 
Fahr. ( Celestins) to 178° Fahr. ( Chaudes Aigues). 

Mont Dor6, valley of the Dordogne, France. 

The waters are weak alkaline, and have a temperature from 90° to 
104° Fahr. Their principal constituent is carbonate of soda. These 
springs lie among the volcanic mountains of Auvergne, at an eleva- 
tion of 3,300 feet. 

Vals, Ardeche, France. 

The waters of these cold springs are remarkable for the quantity of 
carbonate of soda which they contain. They are abundantly charged 
with carbonic-acid gas. 

Ems, on the Lahn, Germany. 

These waters contain, according to the analysis of Fresenius, 14 to 
15 parts of bicarbonate of soda, 7 parts of chloride of sodium, and 1*7 
part each of bicarbonate of lime and bicarbonate of magnesia, with 
sulphates of soda and potash, and bicarbonates of iron, manganese, 



ALKALINE SPRINGS. 205 

baryta, strontia, and alumina in small quantity, to the pint. The gas 
is carbonic acid, from 6 to 8 cubic inches to the pint. 

Neuenahr, valley of the Ahr, between Bonn and Coblentz, Ger- 
many. 

The waters of these springs have a composition similar to those of 
Ems, but have about half as much soda and very little salt. 

Salzbrunn, upper Silesia, near Freiburg, Germany. 

These waters are very rich in carbonate of soda. 

Gleicheilberg, near Gratz, Styria, Austria. 

These springs are much more alkaline than Ems. The waters con- 
tain from 20 to 27 parts of carbonate of sodium, 19 '5 of chloride of 
sodium, and 7*8 of carbonate of magnesium. The water is highly 
charged with carbonic-acid gas. 

Therapeutical Uses of the Alkaline Mineral Waters.— As we have 
seen that alkalies taken before meals increase the production of acid 
gastric juice, the alkaline mineral waters are serviceable in atonic dys- 
pepsia. They are especially useful in catarrh of the duodenum and 
of the bile-ducts, and in the jaundice dependent on this state of the 
mucous membrane. In incipient cirrhosis, in congestion of the portal 
circulation, and in haemorrhoids due to the hepatic obstruction, they 
render important service. Obesity, which is frequently diminished by 
a course of alkalies, is better treated by alkaline waters, for at the 
springs these patients can be induced, more easily, to conform to the 
plan of exercise and diet necessary in these cases. 

The alkaline springs have long had a deserved reputation for 
the cure of gout and rheumatism. With the internal use of the 
waters should be conjoined baths, douches, etc. Gout and rheu- 
matic affections of interned organs are equally amenable to the same 
treatment. 

These alkaline waters, long used, are especially serviceable in the 
so-called lithic-acid diathesis. There is little doubt that the continuous 
use of alkaline waters for a long period will cause the solution of uric- 
acid renal calculi. For this purpose those alkaline waters rich in 
potassa are preferable. 

When diabetes is hepatic in origin, and occurring in obese subjects, 
the alkaline mineral waters are extremely useful. A suitable diet 
should be enjoined. 

The following domestic mineral waters may be advised in the above 
states : Bladon Springs ; the California Seltzer ; Perry Springs ; St. 
Louis Springs ; but especially Capon and the alkaline springs of Wis- 
consin. 

Of the foreign, the most important are Yichy, which is imported 
at a moderate price, Mont Dore, Yals, Ems, Salzbrunn, and Gleichen- 
berg. 

The psychical influences of change of scene, associations, and cli- 



206 AGENTS INCREASING WASTE. 

mate, are largely concerned in the results of treatment with the 
waters of mineral springs. 

SALINE MINERAL WATERS. 
1. North American. 

St. Catharine's Wells, St. Catharine's, Ontario, Canada. 

These contain chloride of sodium (217 to 375 grains to the pint), 
chlorides of potassium, magnesium, calcium (108 to 127 grains to the 
pint), sulphate of lime, and iodide and bromide of magnesium. A 
concentrated water prepared by evaporation is used, properly diluted 
by patients at a distance for internal diseases, and at the wells, ex- 
ternally. 

These waters are diluted with ordinary water to three fourths 
or seven eighths, before they are drunk. They are chiefly used as 
warm baths. The diseases in which they have been found most 
beneficial are chronic gout, rheumatic gout, chronic rheumatism, 
and gouty and rheumatic diseases, strumous diseases, engorgement 
of the pelvic viscera, chronic metritis, uterine fibroids, haemor- 
rhoids, etc. 

Spring Lake Well, Ottawa County, Michigan. 

The water of this spring contains chloride of sodium (50*691 grains 
to the pint), chloride of calcium (14*177 grains to the pint), chloride 
of magnesium, carbonates of soda, manganese, and iron, in small quan, 
tity, sulphate of soda (5*837 grains to the pint), bromide of magnesium - 
and a trace of lithia. 

These waters are applicable to the treatment of gout, rheumatism, 
strumous diseases, etc. The waters are drunk and used as warm 
baths. 

Saratoga Springs, Saratoga, New York. 

In general terms, these waters contain chloride of sodium, the alka- 
line carbonates, and are highly charged with carbonic-acid gas. The 
springs are numerous, and differ somewhat in composition. I subjoin 
a tabular statement (see page 207) of the analyses of the different 
waters, from the excellent work of Dr. Walton. 

These waters are useful in plethora of the abdominal viscera, in 
obesity, in habitual constipation due to deficient secretion, in plethora 
of the pelvic viscera, haemorrhoids, etc. The waters of the Pavilion 
and Geyser Springs, owing to the quantity of lithia which they contain, 
are especially serviceable in chronic gout, chronic rheumatism, rheu- 
matic gout, and affections dependent on these diatheses. The Colum- 
bian, Pavilion, Eureka, and Excelsior, containing a considerable pro- 
portion of iron, are more especially adapted to cases of the above- 
mentioned disorders, in which anaemia exists, but they must be drunk 
with caution by the plethoric. 



SALINE SPRINGS. 



207 



ONE PINT CONTAINS— 


■3 

-Hi 

gSrJ 


-3 
a 

o 


i 


— • 

& fa 

W • 

O 

fa 


it- 

6 8 
|« 


£ 

a 

1 ° 
? fa 


. -3 
|| 

5° 
-a fc," 

Id 

£ v.' 

fa 


■3 
. »: J 

« -« s 

"3 

fa 


Solids. 


Grains. 
3 '024 
4-069 
0-135 

11-443 
154 
trace. 
0-050 
1-122 

48-766 
0-201 


Grains. 
0-934 
9-019 
0-031 

12-449 
0-374 
trace. 
0-095 
1-006 

50-055 
0111 


Grains. 

0372 
13 072 

0-101 
14-815 

trace. 
178 
1-199 
63-746 
trace. 


Grains. 

0-7S2 
3-182 
0-079 
9 520 
0-163 
trace. 
008 
0-536 
63-328 
0346 


Grains. 

1-336 
3 461 
0-698 
8-500 

'33 : 375' 


Grains. 

0-327 
5-650 
0-233 

10-432 
0-744 
trace. 
0-090 
0-958 

57-480 
0-254 


Grains. 
0-405 
5 399 
0-065 
8-0S4 
0-380 

o-ooi 

0-094 

1-078 

17-734 


Grains. 
2-552 


Carbonate of magnesia 


2-9S8 
0155 




7-804 




0-071 




trace. 




trace. 




167 




16-786 




0-069 


























trace. 


0-002 


o-ooi 


0-003 




o-ooi 


0-002 










0-011 
0-091 
trace, 
trace. 
0-153 


0-017 
1-069 
trace, 
trace, 
trace. 


0-025 
0-192 
trace. 

"6 : 6i6* 


o-ooi 

0-033 
trace, 
trace. 
0-052 


0-320 


0-00) 
0-123 
trace, 
trace. 
0*041 


0-006 
0-106 
trace, 
trace. 
012 


0-004 




0-079 




trace. 








0-047 






Silicate of soda 


















Silica 


0-283 
trace. 


105 
trace. 


0-157 
trace. 


0-182 
trace. 


0256 


0-394 
trace. 


0-393 
trace. 


0-320 










Total 


69-502 

Cubic in. 

51 
(1S66.) 


75-267 

Cubic in. 

49 
(1871.) 


93-874 

Cubic in. 
47 


78-215 

Cubic in. 

43 
(1872.) 


47-946 

Cubic in. 
34 


76-745 

Cubic in. 
41 


33-764 

Cubic in. 
30 


31-042 

Cubic in. 
40 


Gas. 





ONE PINT CONTAINS— 


a 
. -'J 

a to . 


.1 

rt? 

Wo * 

1 


1 

c S 
•=< 

fa 


ft 

A 

-x a 
2.3 

PS 


•% a 
(A 


A 
PS 


. -•! 

— -= -a 
* fa ° ' 

z?r fa 

o 
fa 


Solids. 
Carbonate of soda 


Grains. 

6-175 

10-322 

0-039 

14-793 

549 

0-041 

0-206 

3-079 

70-260 

trace. 


Grains. 

1-097 
4-586 
0-110 
10-795 
0-124 
trace. 

o-oio 

1-212 

49-795 

0-675 


Grains. 

1-107 
2-618 

"7-324' 
0-016 


Grains. 
0-625 
3-667 
0-375 
5-165 


Grains. 

1-875 

4-042 
0-402 
9-625 


Grains. 
4-281 
4-3S3 
0-578 

12-249 


Grains. 
1-212 


Carbonate of magnesia 


5-568 


Carbonate of iron 


0-1S5 


Carbonate of lime 


8-S45 
339 


Carbonate of lithia 


Carbonate of strontia 










Carbonate of baryta 










074 


Chloride of potassium 


0-686 
8-699 








1-040 


Chloride of sodium 


20-852 


46330 


37-332 


42-058 


Sulphate of potassa 


269 


8ulohate of soda 






0165 






Sulphate of magnesia 








0-263 






Phosphate of soda 


trace. 


trace. 


trace, 
trace. 






"oooi" 


Phosphate of lime 










Iodide of sodium 


031 
0-276 
trace, 
trace, 
trace. 


0-015 
0-071 
trace, 
trace, 
trace. 


0-583 
0-196 


0-529 


0-449 


6-008 


Bromide of sodium 


051 


Fluoride of calcium 








Biborate of soda 












Alumina 


10 219 


0-029 


"6 : 875 
0-500 




0-033 


Silicate of potassa 




Silicate of soda 














Silica 


0-013 
trace. 


0-160 
trace. 


0-339 


0-067 


2 0-125 


0-401 


Organic matter 
















Total 


105-834 

Cubic in. 

57 
(1870.) 


68-650 

Cubic In. 
50 


21-003 
Cubic in. 


31-827 

Cubic in. 
29 


64-343 

Cubic in. 
31 


59-S97 

Cubic in. 
40 


60 0S9 


Gas. 
Carbonic acid 


Cubic in. 
39 




(1S70.) 



1 Alumina and sesquioxide of iron. 



8 Silica and alumina. 



208 AGENTS INCREASING WASTE. 

Ballston Spa, Ballston, Saratoga County, New York. 

These waters are similar in composition to the waters of the Sara- 
toga Springs, but they are richer in mineral constituents. The propor- 
tion of chloride of sodium ranges from 53*12 grains to 93*753 grains in 
a pint. The Lithian Well contains 13*378 grains of carbonate of 
magnesia, 20*675 grains of carbonate of lime, 4 grains of chloride of 
potassium, to the pint, besides carbonates of soda, iron, lithia, strontia, 
baryta, phosphate of soda, sulphates of potassa and soda, iodide and 
bromide of sodium. Carbonic-acid gas, from 30 to 57 cubic inches. 

These waters are applicable to the treatment of the same cases as 
the Saratoga waters. 

2. EUEOPEAN. 

Cheltenham, Gloucestershire, England. 

These spas are saline aperient, iodureted saline, iodureted-magne- 
sian saline, and the waters contain a good deal of carbonic acid. The 
season is from July to October. These waters are chiefly serviceable 
in dyspepsia, hepatic affections, and constipation. Some of the springs 
at Cheltenham contain iron, and the water of these is employed in 
chlorosis and ancemia. 

Leamington, Warwickshire, England. 

These waters contain chlorides of calcium and sodium, and sulphate 
of soda, with carbonic acid. They are much prescribed in dyspepsia, 
acidity, and hepatic troubles, constipation, etc. 

Adelheidsquelle, Heilbrun, Bavaria. Altitude, 2,000'. Tempera- 
ture of spring, 50° Fahr. Season, May to September. 

This valuable water contains chloride of sodium, carbonate of 
sodium, iodide and bromide of sodium, etc. ; carbonic acid, 13*18 
cubic inches. It is highly prized in strumous diseases, rheumatism, 
gout, affections of the shin, and pelvic troubles of females {chronic 
metritis, fibroids, etc.). 

Baden-Baden. Altitude, 616'. Mean annual temperature, 48° Fahr. 
Season, May to October. 

According to Bunsen's analysis, these waters contain chloride of 
sodium, bicarbonate of lime, magnesia, and iron, sulphates of lime and 
potash, arseniate of iron (a trace), chloride of potassium, bromide of 
sodium (traces), etc. ; carbonic-acid gas. The Meurquelle contains 
2*3694 grains of chloride of lithium in 20 ounces. 

Carlsbad, Bohemia. Altitude, 1,200'. Season, June to September. 

These waters contain sulphate of soda, carbonate of soda, chloride 
of sodium, sulphate of potash, carbonate of lime, etc. Marktbrunnen 
contains, besides these ingredients, a small quantity of carbonates of 
lithia, strontia, and manganese, and iodide and bromide of sodium ; 
the gas is carbonic acid. 

The Carlsbad water is highly prized in affections of the liver and 
portal system, uterine diseases, gout, rheumatism, and diabetes. 



SALINE SPRINGS. 209 

Friedrichshall, Saxe-Meiningen, Germany. Bitter water. 

According to Liebig, this water contains sulphate of soda, 46*51 
grains ; sulphate of magnesia, 39*55 ; chloride of sodium, 61*10; chlo- 
ride of magnesium, 30*25 ; sulphates of potash, 1*52, and of lime, 10*34 
grains. Carbonic-acid gas, 5*32 cubic inches. 

This is aperient, and is used in diseases of the stomach, liver, intes- 
tines, and kidneys. It is imported in quart-bottles, and is much pre- 
scribed as a laxative in habitual constipation, in hepatic troubles, pleth- 
ora of pelvic organs, etc. 

Homburg, Central Germany. Altitude, 600'. Open all the year, 
but the season is from May to September. Temperature, 50° to 53° 
Fahr. 

According to the analysis of Liebig and Hofmann, these waters 
contain chlorides of sodium (79 to 104 grains), potassium, magnesium, 
and calcium, carbonates of lime, magnesia and iron, and sulphates of 
soda and lime. Free carbonic acid, 48 cubic inches. 

In therapeutical action they are laxative, and are prescribed in 
habitual constipation, dyspepsia, abdominal and pelvic plethora, obes- 
ity, hypochondriasis, hysteria, etc. 

Kissingen, Bavaria. Altitude, 800'. Temperature of springs, 50° 
Fahr. The season is from May to September. 

Liebig's analysis has shown that these waters contain chlorides of 
sodium (17*52 to 44*71 grains), potassium, lithium, and magnesium, 
sulphates of lime and magnesia, carbonates of lime and iron, bromide 
and iodide of sodium, etc. They are highly charged with carbonic 
acid. 

Kissingen waters are laxative, and are used in dyspepsia, hepatic 
obstructions, albuminuria, diabetes, etc. 

Kreutznach, Rhenish Prussia. Altitude, 285'. Season is from June 
to September. 

This powerfully alterative water contains chloride of sodium (72 to 
108 grains to the pint), chloride of calcium (13 to 22 grains to the 
pint), chlorides of magnesium, potassium and lithium, carbonate of 
lime and iron, bromide and iodide of magnesium. 

The mother-liquor of Kreutznach contains 2,484 grains of solid 
matter in sixteen ounces. 

These waters are extremely serviceable in constitutional syphilis, 
strumous diseases, affections of the skin, rheumatism, gout, engorge- 
ment of the abdominal and pelvic organs, hepatic diseases, etc. 

Marienbad, Bohemia. Altitude, 1,900'. Season is from May to 
September. 

The principal constituents of this water are sulphate of soda, bi- 
carbonate of soda, chloride of sodium, bicarbonate of lime, bicarbonate 
of magnesia, and salts of lithia, strontia, iron, and manganese, in small 
quantity ; carbonic-acid gas. 
14 



210 AGENTS INCREASING WASTE. 

Laxative, and used in hepatic disorders, dyspepsia, habitual con- 
stipation, gravel, gout, etc. 

Reichenhall, Upper Bavaria. Altitude, 1,407'. Mean temperature 
of spring, 56° Fahr. ; of summer, 64° Fahr. ; of autumn, 54° Fahr. 
Season, July and August. 

Used only for baths. Inhalations are practiced here on a large 
scale. " The compressed-air cure " is also a prominent feature of the 
curative methods. Scrofula, phthisis, and affections of the throat, are 
chiefly treated. 

The waters are rich in chlorides of sodium and magnesia, and sul- 
phates of soda and lime. 

Seidlitz, Bohemia. 

The chief constituents are sulphate of magnesia, sulphate of soda, 
carbonate of lime, sulphate of lime, sulphate of potash, and chloride 
of magnesium. 

Saline purgative. 

Selters, Nassau. 

Kastner's analysis has shown that this water contains bicarbonate 
of soda, chloride of sodium, bicarbonates of lime and magnesia, iron 
and manganese, phosphates of lime, alumina and soda, bromide of 
sodium, etc. Highly charged with carbonic acid. 

Laxative and alterative. 

Authorities referred to : 

Braun, Dr. Julius. Systematischcs Lehrbuch der Balneotherapies Berlin, 1873. 

Macpherson, Dr. John. The Baths and Wells of Europe, second edition, London, 
Macmillan & Co., 1873. 

Moorman, Dr. J. J. Mineral Springs of North America, Philadelphia, J. B. Lippin- 
cott & Co., 18*73. 

Yalentiner, Dr. Th. Handbuch der allgcmeinen und speciellen Balneotherapie, Ber- 
lin, 1873. 

Walton, Dr. George E. Mineral Springs of the United Stales and Canada, 

AMMONIUM AND ITS PREPARATIONS. 

Peepaeations. — Ammonii Benzoas. Benzoate of ammonium. 
Benzoic acid and ammonia. In minute, white, shining, thin, four-sided, 
laminar crystals; bitter, saline, and somewhat balsamic in taste; soluble 
in water (1 in 5), and in rectified spirit (1 in 12). Dose, gr. v — gr. xv. 

Ammonii Carbonas. — Carbonate of ammonium. Id white, trans- 
lucent masses, with a pungent and ammoniacal odor, soluble in water 
(1 in 4). Dose, gr. v — gr. x. 

Ammonii Chloridum. — Purified chloride of ammonium. Sal-am- 
moniac. In a snow-white, crystalline powder, soluble in three parts 
of cold water, and sparingly soluble in alcohol (1 in 55). Dose, gr. 

Trochisci Ammonii Chloridi. — Troches of chloride of ammonium. 



AMMONIUM. 211 

(Ammonium chloride, sugar, tragacanth, and sirup of tolu.) Each 
troche contains two grains of chloride of ammonium. 

Ammonii Vcderianas.- — Valerianate of ammonium. A white salt 
in quadrangular plates, having the odor of valerianic acid, and a sharp, 
sweetish taste, and is very soluble in water and in alcohol. Dose, gr. 

J— g r - ▼• 

Ammonii Phosphas. — Phosphate of ammonia. In colorless, trans- 
parent prisms, soluble in water (1 in 4), but insoluble in alcohol. Dose, 
gr. v— 3]. 

Aqua Ammonice. — Water, or solution, of ammonia ; contains ten 
per cent by weight of gas. A transparent, colorless liquid, having a 
very pungent odor, and a strongly alkaline reaction. Dose, r\ v — 
3 ss, well diluted with water. 

Liquor Ammonii Acetatis. — Solution of acetate of ammonium. 
Spirit of Minderer. Dose, 3 j — ? j. 

Spiritus Ammonice. — Spirit of ammonia. A solution of ammonia- 
cal gas in alcohol. Dose, ttj, x — 3 j. 

Spiritus Ammonice Aromaticus. — Aromatic spirit of ammonia. 
Solution of carbonate of ammonia and aqua ammonise, oils of lemon, 
pimento, and lavender, in alcohol and water. Dose, 3 ss — 3 ij. 

Linimentum Ammonice. — Liniment of ammonia. Cotton-seed-oil 
and aqua ammoniae (30 parts to TO). 

RaspaiVs Eau S'edatif. — Liquor ammonia?, two ounces ; chloride 
of sodium, two ounces ; camphorated spirits of wine, three drachms ; 
water, thirty-two ounces. (Not official.) 

Antagonists and Incompatibles. — The vegetable and mineral 
acids, acidulous salts, earthy salts, and lime-water, are incompatible 
with the carbonate. In addition to the acids, potash, soda and their 
carbonates, salts of lead, silver, and metallic sulphates, are incompati- 
ble with the solution of the acetate. The persalts of iron, acids, 
and liquor potassae, are incompatible with the benzoate. Alkalies, 
alkaline earths and their carbonates, and lead and silver salts, are in- 
compatible with the muriate. In the treatment of poisoning by am- 
monia or its carbonate, the vegetable acids should be used to neu- 
tralize the poison, and its irritant action on the mucous membrane 
should be limited as much as possible by the administration of oil and 
demulcents. 

Therapeutically, ammonia is antagonized by veratrum viricle, aco- 
nite, digitalis, cold, and other cardiac sedatives. 

Synergists. — The action of ammonia is favored by heat, opium, 
iodine, by the antispasmodics, as valerian, asafcetida, etc., by the diffu- 
sible and aromatic stimulants, as alcohol, ether, etc. The therapeutical 
activity of the iodides and bromides is promoted by combination with 
carbonate of ammonia. 

Physiological Action. — Ammoniacal gas, brought in contact with 



212 AGENTS INCREASING WASTE. 

a mucous surface, irritates it ; applied to the eye, it reddens the con- 
junctiva, and causes lachrymation ; applied to the nares, it reddens the 
mucous membrane, produces a sense of heat and burning, and increases 
the secretion of mucus. Inhaled, an overpowering sense of suffocation 
is experienced, and the glottis spasmodically closes. Prolonged contact 
with the air-passages excites violent inflammation. When solution of 
ammonia is swallowed, an active and destructive inflammation of the 
mucous membrane is set up ; the lips, tongue, soft palate, and tonsils 
are swollen, red, and glazed ; the epiglottis, and especially the arytseno- 
epiglottidean folds, become cedematous, and sudden death may ensue 
from oedema of the glottis. Inflammation of the oesophagus, and of a 
limited portion of the stomach, will also follow the introduction of any 
portion of the irritant. Narrowing (stenosis) of the pyloric orifice has 
been noted, in one case, as an after-result of the inflammation set up in 
this part. In the stomach, ammonia and its carbonate must quickly 
combine with the acid, and probably enter the blood in such combina- 
tion. Increased action of the heart is produced by its administration by 
the stomach, but much more decidedly when it is thrown directly into 
a vein. After the intra-venous injection of ammonia, the blood-pressure 
at first rises, then falls below the normal. Resulting, doubtless, from 
the increased action of the heart, and the more rapid circulation of the 
blood, a subjective sensation of warmth throughout the body is expe- 
rienced, the face becomes flushed, the eyes are more brilliant, and the 
mental operations increase in activity. Little is known of the behavior 
of ammonia in the blood, which in the normal state contains this gas. 
Although it is now known that the coagulation of the blood is not 
caused by the escape of ammonia, as supposed at one time by Richard- 
son, yet ammonia helps to maintain the fluidity of the blood, as its 
presence, in sufficient quantity, certainly serves to hold the fibrin in 
solution. 

The long-continued use of ammonia impairs digestion, by neutraliz- 
ing the gastric juice. Increased waste of tissue is also one result of its 
administration, manifested by pallor, emaciation, and feebleness. When 
introduced into the blood in sufficient quantity, it damages the structure 
of the red blood-globules, and in this way also it affects the nutrition 
of the body, besides the action which it has, in common with the other 
alkalies, of increasing the rate of waste or retrograde metamorphosis. 

The summary of the physiological actions of ammonia, above given, 
pretty fairly represents the movement of these agents as a group ; but 
individual differences undoubtedly exist, which will be pointed out 
when the therapy is considered. 

Therapy. — Ammonia and its carbonate are sometimes used to 
diminish acidity of the stomach -juices. Obstinate vomiting, after irri- 
tating substances are removed, and when the vomited matters are acid, 
may be relieved by the use of the carbonate, or better, by an excess of 



AMMONIUM. 213 

carbonate in solution of the acetate. The acidity, gaseous eructations, 
and abdominal distention, which accompany attacks of hysteria in some 
females, may be quickly removed by the aromatic spirit of ammonia. 
Nervous headache, especially when it is present with the last-mentioned 
group of symptoms, is speedily relieved by the aromatic spirits and the 
carbonate ; but true migraine, although these preparations of ammonia 
may palliate it, is generally more certainly relieved by the bromides. 
RaspaiPs eau sedatif often gives great comfort in headache, when 
locally applied. 

In gastric and intestinal catarrh, chloride of ammonium is held in 
high repute by our German confreres. It is certainly highly serviceable 
in some hepatic disorders — for example, in catarrh of the bile-ducts and 
in the jaundice arising from this cause. In the first stage of cirrhosis, 
before contraction and induration have occurred, it is also useful. The 
nauseous saline taste of the sal-ammoniac is best covered by fluid ex- 
tract of taraxacum or extract of liquorice. The fluid extract of tarax- 
acum is to be preferred as the vehicle in hepatic disorders, because 
this drug has reputed virtues in these cases. When there is deficiency 
of secretion of the intestinal juices, constipation, and a coated tongue, 
with scanty and high-colored urine (so-called bilious state), sal-ammo- 
niac is one of the remedies which may be used with success. That 
this drug has a selective action on the liver seems probable from the 
fact that it increases the excretion of urea by the kidneys. 

To stimulate the action of the heart when it flags, the ammonia prep- 
arations have an undoubted effect ; hence in adynamic states they are 
frequently used. When employed for this purpose, small doses fre- 
quently repeated (every half -hour or hour) are necessary, owing to 
the fact that ammonia is quickly eliminated. It is a most common 
practice to inhale ammonia to prevent that depression of the heart's 
action called fainting. It should not be forgotten that ammonia, in- 
cautiously inhaled, may give rise to inflammation of the fauces and 
glottis. The preparations of ammonia (spirits, carbonate, water of) 
possess a high degree of utility when thrombosis is actually existent, 
but especially when threatened, as in the puerperal state, after free 
hemorrhage, when the circulation is languid from weak heart, a state 
of hyperinosis being present. It is perfectly safe and legitimate under 
these circumstances to practice the intra-venous injection of aqua am- 
moniae, 3 j — 3 ij, diluted with an equal measure of water. This practice 
seems more particularly advisable when sudden thrombosis of a large 
venous trunk ensues — as, for example, in the pulmonary artery, after 
uterine haemorrhage. In sudden paralysis of the heart from chloro- 
form narcosis, the bite of venomous snakes, etc. , this practice has been 
resorted to, but hitherto without any recognized success. As regards 
the intra-venous injection of ammonia as a remedy for the bite of 
venomous snakes, Brunton and Fayrer have shown that this practice 



/ 



214 AGENTS INCREASING WASTE. 

is without value. Ammonia is a physiological antagonist to hydro- 
cyanic acid, and is used in poisoning by this agent ; it counterbalances 
the depression, and maintains the heart's action, until the effects of the 
poison are spent. 

Carbonate of ammonia is one of the remedies occasionally success- 
ful in the treatment of delirium tremens. It is indicated, and proves 
most serviceable, when there is present anemia of the brain, and the 
heart's action is feeble. Half -ounce doses of solution of ammonia ace- 
tate are said to remove the effects of alcoholic intoxication. The vale- 
rianate of ammonia and the aromatic spirits of ammonia abort or 
prevent paroxysms of hysteria. Nervous headache and also migraine 
may sometimes be cured by the various preparations of ammonia ; but 
of these the muriate is exceptionally serviceable. Indeed, Dr. Anstie 
affirms that this agent, if given early enough, seldom fails to cut short 
an attack of migraine. It should be administered in doses of from ten 
to twenty grains. In myalgia, or muscular neuralgia, it is equally 
effective, according to the same authority : $ Ammonii choridi, | ss; 
ext. cimicifugse fluidi, f j ; glycerini, % ij ; syrupi tolu, aquae lauro- 
cerasi, aa § j. M. Sig. : A teaspoonful three or four times a day. 
In other neuralgiae the muriate of ammonia is occasionally useful, but 
by no means so curative as in migraine and myalgia. 

The preparations of ammonia are classed with the stimulant expec- 
torants. It is an interesting fact, in this connection, that they are elimi- 
nated largely by the lungs ; and it is probable, indeed, that in thus 
escaping they stimulate secretion and liquefy the products of inflamma- 
tion. In bronchorrhoea and chronic bronchitis, muriate of ammonia 
renders important service. It is given in extemporaneous prescriptions 
with extract of liquorice, and may be combined with other stimulating 
expectorants when no incompatibility exists : r> Ext. eucalypt., fl 1 j; 
ammonii chloridi, 3 ij ; ext. glycyrrhizse, 3 ij ; glycerini, § iij. M. 
Sig.: A teaspoonful four or six times a day. When great depression 
exists in pneumonia, carbonate of ammonia is given with advantage. 
It should be remembered that to stimulate the heart merely, when 
an obstacle exists in the pulmonary circulation, is of doubtful utility ; 
but ammonia liquefies the exudation, and thus removes obstruction 
of the air-sacs ; hence it becomes a remedy of great value during this 
stage up to the period of crisis. When there is much adynamia in 
these various pulmonary inflammations, the carbonate of ammonia is 
frequently prescribed in infusion of senega, a stimulating expectorant. 

Extraordinary success has been claimed for carbonate of ammonia 
in variola, scarlatina, rubeola, and erysipelas. A convenient mode of 
administration is to dissolve the carbonate in the solution of the ace- 
tate. The indications for the use of the carbonate are, feeble circula- 
tion, cyanosis, delirium. As these are self-limited diseases, the mild 
cases do quite as well without drugs. 



BARIUM. 215 

Carbonate and acetate of ammonia are much prescribed in continued 
fevers — the latter as a so-called febrifuge ; the former when decided 
adynamia ensues. In typhoid the diarrhoea may be increased by the 
solution of the acetate. As in typhus and typhoid the ammonia in the 
blood is increased above the normal, it has seemed to the author im- 
proper practice to administer ammonia as a remedy in these diseases, 
and his observations have convinced him that it has no good effects 
which can not be better procured by other means. 

The chloride of ammonium is said to be an excellent emmenagogue 
in from ten to twenty grains. 

Local Uses of Ammonia. — Ammoniacal gas, cautiously inhaled, 
sometimes gives relief to acute catarrh, and in hay-asthma. Its good 
effects are limited, however, to that stadium of these maladies in which 
the morbid action is confined to the nasal passages, and the discharge 
is yet serous rather than purulent. The pain and smarting which 
attend the sti?igs of insects are alleviated by the application of diluted 
aqua ammonia?. The strong aqua ammonia? should be at once applied 
to the Mte of venomous serpents, and of rabid animals. 

Ammonia is frequently employed as a counter-irritant in the form 
of the well-known volatile liniment. As a vesicant it is also used when 
a prompt action is desired, but it is rather uncertain. 

A solution of sal-ammoniac in alcohol and water is an excellent dis- 
cutient application in inflammatory swellings : ^ \ Ammonii chloridi, 
3 ij ; spts. vini rectif., aqua?, aa § ij. M. Sig. : Lotion. Cloths moist- 
ened with the solution can be frequently applied, and the cases in 
which it is applicable are the following : Orchitis, inflamed joints, 
sprains, and loccd and external inflammations generally. 

Authorities referred to : 

Anstie, Dr. F. E. On Muriate of Ammonia as a Remedy for some Nervous Disorders. 
The Practitioner, vol. i, p. 356. Ibid., vol. xi, p. 318. 

Ibid. Neuralgia and its Counterfeits, pp. 190, 232. 

Bellini, Dr. Ranieri. The Action of Ammonia and its Preparations. British Medi- 
cal Journal, 1874, p. 415. 

Brunton and Fayrer, Drs. Proceedings of the Royal Society, No. 149, 1874, p. 132. 

Koehler, Dr. Hermann. Handbuch der physiologische Therapeutik und Materia 
Medica, erste Halfte, Gottingen, 1875, p. 229, Ammonii preparata. 

Lange, Dr. Archiv fur experimented Pathologie und Pharmakologie, 1874, p. 225. 
Tlie action of ammonia on the human organism. 

Xothnagel, Dr. Hermann. Handbuch der Arzncimittellehre, Berlin, 1S70, p. 540. 

Stevenson, Dr. Thomas. Guy's Hospital Reports, Series III, vol. xvii, p. 225. Poi- 
soning by liquor ammonia. 

Taylor, Dr. A. S. On Poisons, Philadelphia edition, p. 299. 

BARIUM AXD ITS PREPARATIONS. {Not Official) 
Barii Chloridum. — Chloride of barium. Occurs in colorless, 
translucent tablets. It is soluble in diluted alcohol, and freely and en- 
tirely soluble in water. Dose, gr. ss — gr. v. It may be administered 



216 AGENTS INCREASING WASTE. 

in pill form, or in solution, when it should be given well diluted with 
water. 

Antagonists and Incompatibles. — Sulphates, phosphates, and 
carbonates, and most of the salts of organic acids, are incompatible 
with it. Nitrate of silver decomposes it. When it is prescribed, it 
were better to avoid combinations, owing to the numerous incompati- 
bilities to which it is subject. The sulphates are ready antidotes, as 
sulphates of magnesium or sodium. 

Synergists. — The alkalies, and metallic salts from the therapeu- 
tical stand-point, increase its action on the retrograde metamorpho- 
sis. Ergot and digitalis favor its influence over the sympathetic 
system. 

Physiological Actions. — The soluble salts of barium have a disa- 
greeable, bitter, and astringent taste. In a full medicinal dose irrita- 
tion of the stomach is caused, and a sense of heat and burning is 
developed at the epigastrium. In one case (Ferguson) symptoms of 
poisoning came on in a week, produced by one twelfth of a grain of 
chloride of barium, administered three times a day, the whole amount 
taken being two and a half grains. The symptoms were extreme ex- 
haustion and nervousness. An idiosyncrasy must have existed here, 
as so small an amount would not, under ordinary circumstances, have 
produced such decided effects. The usual symptoms in cases of poi- 
soning are intense anguish, free salivation, great thirst, loss of voice, 
violent vomiting and purging, dilated pupils, frequent micturition, 
respiration slow and labored, pulse slow, increasing weakness, and 
finally complete paralysis of the extremities. The intelligence is pre- 
served until near the end, when convulsions and coma come on. The 
post-mortem rigidity is very decided. There are present very con- 
siderable bronchial effusion and hyperemia of the lungs, the heart is 
distended with black blood, and the brain is engorged. The stomach 
presents the usual appearances ; there is intense hyperaemia, and 
sometimes perforation of this organ. The quantity necessary to cause 
death varies greatly — two and a half grains have brought on serious 
symptoms, and half a teacupful of the carbonate has been recovered 
from. One drachm of the chloride has caused death in seventeen 
hours, and one ounce of the same salt in one hour (Woodman and 
Tidy). 

The effects on animals have been studied by Onsum, Cyon, Bohm, 
and myself (unpublished). Onsum held that the symptoms produced 
by the soluble salts of barium, when injected into the blood, were due 
to the formation of the insoluble sulphate. Cyon criticises this view, 
and shows that it is incorrect. The most elaborate, as it is the most 
recent, account of the physiological effects of the barium salts is that 
of Bohm. The statement to follow is based on this paper chiefly, and 
on the author's personal researches. In frogs, after injection of the 



BARIUM. 217 

chloride into the lymph-sac, extension and rigidity of the voluntary 
muscles ensued, followed by relaxation and paresis. The belly becomes 
distended and the intestines are thrown into active movements ; the 
mouth is held wide open and a watery fluid continually escapes, while 
from the skin a mucus-like secretion exudes. When given to warm- 
blooded animals by the stomach, profuse secretion takes place, active 
peristalsis of the bowels and copious alvine discharges, and free urina- 
tion follow, but not until about a half -hour after the ingestion of the 
poison. If thrown into the veins the same symptoms arise immedi- 
ately : in either case the tonic and clonic convulsions followed by 
paralysis occur ; the pupils dilate ; the heart is slowed, but its contrac- 
tion is more energetic ; the tension increases enormously in the arte- 
rial system after a preliminary fall, and finally insensibility and coma 
terminate the action. Very large doses, suddenly precipitated on the 
heart by injection into the jugular vein, will induce paralysis both of 
the heart and lungs. With the peripheral paralysis labored breathing 
ensues, due to paresis of the respiratory muscles, and death is caused 
rather by this than by cessation of the heart's action, when the poison 
is introduced subcutaneously. The paralysis in animals begins in the 
hind extremities. This paralysis is preceded by fibrillary trembling 
and clonic spasms mixed with tonic rigidity. The muscular contrac- 
tility is entirely abolished when the paralysis is complete. On the 
nervous system of organic life barium chloride acts as a stimulant. 
The strong cardiac contractions, the dilated pupil, the energetic peris- 
talsis of the bowels, the closure of the lumen of the intestines and also 
of the bladder, and the almost complete approximation of the periph- 
eral vessel-walls, are the proofs of this excitation. 

Therapy. — Having actions in some respects like digitalis and 
ergot, barium salts are indicated in diseases to the treatment of which 
these remedies have been applied. Influenced by the observations 
of Bohm, probably, Dr. Flint, of Leeds, England, has employed the 
chloride of barium successfully in the treatment of aneurism. The 
case was one of abdominal aneurism, in a woman of sixty-five. Tuf- 
nell's treatment had been carried out faithfully for five months with- 
out success, and iodide of potassium, for some unexplained reason, 
could not be taken. Chloride of barium was, after careful considera- 
tion, selected, and one fifth of a grain three times a day was adminis- 
tered three or four weeks, when it was increased to two fifths. The 
curative effect was very manifest, for after nearly five months of con- 
tinued use of the same remedy the tumor was so reduced that it 
could be scarcely felt. Chloride of barium will probably prove use- 
ful in hemorrhage, in acute congestion of organs, in atony of the in- 
testines with deficient secretions, in atony of the bladder, in weakness 
of the heart with low arterial tension, etc. 



218 AGENTS INCREASING WASTE. 



VEGETABLE ACIDS. 



Acidum Aceticum. — Acetic acid. Liquid; specific gravity 1*048. 
Colorless, having a pungent and characteristic odor. Of this acid one 
hundred grains neutralize sixty grains of bicarbonate of potassium. 

Acidum Aceticum Dilutum. — Diluted acetic acid. Seventeen parts 
of the acid to eighty-three parts of water. 

Acidum Citricum. — Citric acid. In colorless crystals, freely solu- 
ble in water and soluble in alcohol. One hundred grains of citric acid 
neutralize one hundred and fifty grains of carbonate of potassium. 

Acidum Tartaricum. — Tartaric acid. In colorless crystals, wholly 
or almost wholly dissipated by heat, and readily soluble in water. 
One hundred grains of tartaric acid saturate one hundred and thirty- 
three and a half grains of bicarbonate of potassium. 

Antagonists and Incompatibles. — The alkalies are the chemical 
antagonists ; yet, from the physiological point of view, the ultimate 
results of their action place them in the same division of remedial 
agents. Therapeutically, the acids are antagonized by those agents 
which promote constructive metamorphosis. 

Synergists. — The alkalies and agents promoting waste favor the 
therapeutical actions of the vegetable acids. 

Physiological Actions. — The vegetable acids, undiluted, have a 
sharp, pungent, and rather acrid taste ; but, when considerably diluted, 
they are rather agreeable and refreshing. They have the property to 
diminish the sense of thirst, to abate heat and the restlessness of fever. 
In large quantity, they possess considerable caustic power, j>roducing 
gastro-enteritis and the systemic symptoms belonging thereto. These 
systemic symptoms, especially the slowing of the heart, have been 
incorrectly, the author thinks, attributed to a special power of these 
agents to affect the action of the heart. 

There can be no doubt that these acids obey the chemical laws of 
combination, and unite with alkalies to form salts, in which form they 
enter the blood. The most important question connected with the 
physiological action of these agents is, the disposition of them in the 
blood. The most recent and elaborate examination of this point is the 
" Memoir " of Friedrich Walter. This research appears to have deter- 
mined that these acids do not have the power to neutralize the alka- 
linity of the blood, as has heretofore been supposed. That they are 
in part destroyed in the organism by the ozonizing action of the blood, 
seems undoubted. Carbonic acid is one of the products, and the pres- 
ence of this, we may assume, accounts for the increased acidity of 
the blood and of the urine, which follows the administration of these 
agents. 

They are eliminated by the intestinal canal, and chiefly by the kid- 
neys. They increase secretion from the intestinal mucous membrane, 



VEGETABLE ACIDS. 219 

and are apt to produce tormina, flatulence, and diarrhoea. It is proba- 
ble that these intestinal effects are in part due to the fact that the salts, 
formed by combination of the acids in the canal, escape absorption and 
act locally as they descend. 

These acids, or the salts formed by their combination, have a de- 
cided power to promote diuresis. In this result all of the urinary con- 
stituents are included ; but it is chiefly the water which is increased. 
To these general statements some exceptions must be made. Thus, 
citric and acetic acids are entirely destroyed in their passage through 
the organism ; benzoic acid is converted into hippuric ; and tartaric, 
citric, and malic are converted into carbonic after combination with 
alkali only. Furthermore, benzoic acid does not increase any of the 
urinary constituents. 

Ultimately, wasting and emaciation, a watery condition of the 
blood, a scorbutic state, indeed (Bence Jones), are the results of the 
action of these agents. 

Therapy. — Acetic acid applied to the skin has some superficial 
caustic property. This is made use of to cure small warts and vegeta- 
tions of the skin. It is applied with a pine stick. Parasitic affec- 
tions of the skin are similarly treated, as, for example, pityriasis. 

Internally the acids, chiefly citric, in the form of lemonade, are used 
as a refreshing drink in fevers. They allay restlessness by relieving 
thirst, and they also act upon the skin and kidneys. Lime-juice is 
the most important antiscorbutic, and constitutes part of the equip- 
ment of every vessel on long voyages. It should not be forgotten 
that the use of lemon-juice may cause precipitation of uric acid, and 
thus favor the formation of calculi, as has been pointed out by Bence 
Jones. 

Lemon-juice was at one time the fashion in the treatment of acute 
rheumatism ; but more efficient remedies have taken its place. 

Acids are serviceable in various disorders of the digestive tract ; 
given before meals, they check the formation of acid, and thus re- 
lieve acidity. An acid and dry wine — as, for example, a Rhenish 
wine — may sometimes serve a useful purpose. The juice of a lemon 
may be taken before meals with the same object. But it is true that 
the mineral acids are to be preferred for this purpose. Very injurious 
effects are produced by the long-continued use of lemon-juice in such 
cases. It is sometimes taken by young ladies to keep down the for- 
mation of fat ; but it accomplishes this object by impairing digestion. 

Authorities referred to : 

Jones, Dr. II. Bence. Lectures on Materia Medica. The Medical Times and Gazette, 
^October, 1854, p. 408. 

Park.es, Dr. E. A. On the Urine, 1860, p. 146. 

Walter, Friedrich. Uniersuchungen uber die Wirkung der Sduren auf den thierisch- 
en Organismus. Archiv f. exper. Pathol, u. Phar., 18^77, p. 148. 



220 AGENTS INCREASING WASTE. 



SULPHUROUS ACID AND THE SULPHITES. 

Acidum Sulphur sum. — Sulphurous acid. A colorless liquid, hav- 
ing the odor of burning sulphur, and a sulphurous, sour, and somewhat 
astringent taste. Dose, vi v — 3 j. 

Sodii Hyposulphis. — Hyposulphite of sodium. In large, colorless, 
transparent crystals, having a bitter, slightly alkaline, and sulphurous 
taste. It is soluble in one and a half part of water at 60°, and insolu- 
ble in alcohol. Dose, grs. v — 3j. 

Sodii Sulphis. — Sulphite of sodium. In white, efflorescent, pris- 
matic crystals, soluble in four parts of cold and in less than one part 
of boiling water. It has a sulphurous taste, and a feeble alkaline reac- 
tion. Dose, grs. v — 3j. 

Sodii BisulpMs. — Bisulphite of sodium. Opaque, prismatic crys- 
tals, or a crystalline or granular powder, slowly oxidized and losing 
sulphurous acid on exposure to air, having a faint sulphurous odor and 
taste, and an acid reaction ; soluble in four parts of water at 60° Fahr., 
and in two parts of boiling water. Dose, grs. iij — grs. x. 

Potassii Sulphis. — Sulphite of potassium. In white, opaque frag- 
ments or powder, very soluble in water. It has a saline and sulphurous 
taste. Dose, grs. iij — grs. x. 

Magnesii Sulphis. — Sulphite of magnesium. " A white, crystalline 
powder, gradually becoming oxidized on exposure to air, odorless, 
having a slightly bitter, somewhat sulphurous taste, and a neutral or 
slightly alkaline reaction." It is insoluble in alcohol but is soluble in 
twenty parts of water at 60° Fahr. Dose, grs. v — 3j. 

Antagonists and Incompatibles. — The mineral acids — including 
sulphuric — decompose the sulphites and hyposulphites. All oxidizing 
substances are incompatible. These preparations have a great affinity 
for oxygen, and the sulphites readily become sulphates. 

Synergists. — All remedial agents which arrest fermentative pro- 
cesses promote the therapeutical activity of sulphurous acid and the 
sulphites. 

Physiological Actions. — Sulphurous acid is a disinfectant and de- 
odorizer. It attacks organic matter with energy, by virtue of its affinity 
for oxygen. It is very destructive to the lower forms of life, bacteria, 
fungi, etc. Sulphurous-acid gas inspired produces great irritation of 
the glottis, and an intensely suffocative feeling. In sufficient quantity 
it produces violent inflammation of the air-passages. As by combina- 
tion with oxygen sulphuric acid is formed, the destructive effect as- 
cribed to sulphurous acid is in reality chiefly due to sulphuric. 

The sulphites exposed to the air rapidly absorb oxygen, and pass to 
the state of sulphates. The hyposulphites are more constant than the 
sulphites. In the stomach, by the acid of the gastric juice, these salts 
are in part decomposed and sulphurous acid is given off ; in part they 



SULPHUROUS ACID. 221 

are converted into sulphates. They are undoubtedly absorbed as sul- 
phates, and are eliminated partly by the intestinal canal, but chiefly by 
the kidneys, as sulphates. The author demonstrated these facts soon 
after the publications of Dr. Polli led to an enthusiastic administration 
of these remedies in the zymotic diseases. 

Therapy. — Dilute sulphurous acid is one of the numerous local ap- 
plications considered efficacious in mercurial stomatitis, aphthae, mucous 
patches, ulcers of the tonsils, and in diphtheria. In all of these affec- 
tions the diluted acid may be applied directly to the diseased surface 
by a mop, a sponge-probang, or in the form of spray. A more easily- 
managed application is a solution of the sulphite of soda ( 3 j — 1 j in 
water). Sulphurous-acid spray is a good local application in syphilitic 
and tuberculous laryngitis. Cases of chronic bronchitis, with profuse 
expectoration of a fetid character (bronchorrhcea), are sometimes im- 
proved by inhalations of sulphurous-acid gas, or of the acid in the 
form of spray. Notwithstanding the confident assertions of Dewar, 
there is no reason to suppose that sulphurous-acid-gas inhalations can 
actually cure or even arrest the progress of phthisis. 

In certain kinds of vomiting of a yeast-like material, especially when 
sarcina are present in the vomited matters, the sulphites are often 
curative. Vomiting of acid matters, pyrosis, and indigestion, due to 
acid fermentation of the starchy and saccharine elements of the food, 
are relieved by sulphurous acid (tti v — 3 j, well diluted), or, but less 
efficiently, by sulphite of soda (3j — 3 j). The result in these cases 
is, no doubt, due to the power which sulphurous acid has of arresting 
the fermentation processes. 

After the publications of Dr. Polli, of Milan, extravagant expecta- 
tions were entertained of the curative power of the sulphites in the 
zymotic diseases generally, and in all the various forms of septic dis- 
eases. Unfortunately, these expectations have not been realized, and 
the sulphites are no longer employed with this view in any of these 
disorders ; and, as Braun and Bernatzik have shown, they are not only 
nauseous in taste but they produce more or less irritation of the intes- 
tinal canal, and do not in any case modify the course of the disease. 

Externally applied, sulphurous acid and the hyposulphites and sul- 
phites are in some maladies extremely serviceable. 

As a disinfectant and deodorizer sulphurous acid is at the same time 
efficient, easily managed, and economical. Sulphurous acid is the prod- 
uct of the combustion of sulphur in the open air ; hence, to disinfect 
rooms, it is necessary only to close all egress and fill them with the 
fumes of burning sulphur. It is to be remembered that sulphurous acid 
is injurious to many fabrics : the sulphites are colorless and soluble. 

Sulphurous acid is an efficient application to chilblains : I£ Acid, 
sulphurosi, 3 iij ; glycerini, 3 j ; aquae, f jss. M. In parasitic skiii-dis- 
eases, the sulphites, hyposulphites, and sulphurous acid, are used to 



222 AGENTS INCREASING WASTE. 

destroy the parasites. The following formula is employed by Startin 
in these affections : ^ Sodii hyposulphitis, § iij ; acid, sulphurosi dil., 
| ss ; aquae q. s. ad J xvi. Fox recommends the following formula in 
tinea versicolor and in pruritus vulvas : t> Sodii hyposulphitis, 3 iv ; 
glycerini, 3 ij ; aquae destil. ad § vi. 

Sulphurous acid is an excellent application to ill-conditioned, slough- 
ing, or gangrenous wounds. It was found to be very successful in 
these cases, at the English hospital at Metz, during the Franco- 
German War. 

Authorities referred to : 

Bartholow, Dr. Roberts. The Lancet and Observer, Cincinnati, 1865. 

Braun and Bernatzik, Profs. Wiener med. Wochcnschrift, Nos. 94-99, 1869. 

Bird, Dr. Robert. The Practitioner, vol. ii, p. 247. 

Drtsdale, Dr. Charles R. The Lancet, July 24, 1869. 

Dewar, Dr. James. On the Application of Sulphurous- Acid Gas to the Prevention, 
Limitation, and Cure of Contagious Diseases, Edinburgh, 1866. 

Fergus, Mr. The Lancet, November 26, 1860. 

Fox, Dr. Tilbury. Skin Diseases, New York, 1873. 

Miller, Dr. Edinburgh Medical Journal, September, 1869. 

Polli, Prof. Various Papers. Abstracts in Schmidt's Jahrbucher dcr gcsammten 
Medicin, etc. 

Purdon, Dr. H. S. British Medical Journal, May 9, 1868. 

Sulphur and Sulphides (Sulphurets). — Potassa Sulphureta. Sul- 
phurated potassa has a brownish-yellow color when freshly broken. 
It dissolves in water, with the exception of a slight residue, and forms 
an orange-yellow solution, which exhales the odor of hydrosulphuric 
acid. Dose, gr. j — gr. v. 

Calx Sulphureta. — Sulphurated lime. A greenish-gray powder, 
having a strong odor of sulphureted hydrogen. Dose, gr. j — gr. v. 

Antagonists and Incompatibles. — Solutions of the sulphides are 
decomposed by the mineral acids, sulphureted hydrogen being liber- 
ated and sulphur precipitated. Solutions of the metals, generally, are 
also incompatible with the sulphides of potassium and calcium, for, in 
the decomposition which ensues, the metals are precipitated in the form 
of insoluble sulphides. Hence it is that these preparations have been 
proposed as antidotes to the metallic poisons. Chlorine-water, chlo- 
rides of sodium and potassium, sulphate of iron, etc., are chemical 
antidotes. 

Synergists. — All agents promoting waste are, therapeutically con- 
sidered, synergistic. Alkalies favor their action, both chemically and 
physiologically. 

Physiological Actions. — These preparations have a decidedly nau- 
seous taste and smell, and are somewhat irritant. In the stomach they 
excite a sense of heat, and in sufficient quantity cause gastro-enteritis, 
with all the attendant symptoms belonging to irritant poisons. Dis- 



SULPHURETS. 223 

agreeable eructations of sulphureted hydrogen take place when they 
are administered medicinally, owing to the reactions in the presence 
of an acid alluded to above. They increase secretion from the gastro- 
intestinal canal, and are laxative. The fetor of the stools is increased by 
their use, a result not altogether due to the evolved sulphureted hydro- 
gen, but to the increased action of those intestinal glands concerned in 
elimination. As the sulphides pass easily to the state of sulphates by 
the action of oxygen, it may be assumed that a part of their physio- 
logical effects is produced by the latter salts. They, however, un- 
doubtedly exercise a toxic action on the blood, impairing the red 
blood-globules, and increasing the amount of effete material. Ema- 
ciation, muscular weakness, and trembling, and a feeble circulation, 
are results of their use in large amount, or for lengthened periods. It 
is true that some acceleration of the pulse-rate and increase of secre- 
tion of the mucous surfaces follow their medicinal administration for 
a short period and in moderate doses ; but the prolonged inhalation of 
sulphureted hydrogen, or the prolonged internal use of the sulphides, 
causes great anaemia, wasting, and debility. 

Therapy. — Although the sulphides are indicated as remedies when 
the secretions of the intestinal glandular appendages are deficient, they 
are too disagreeable to be prescribed under ordinary circumstances. 
The water of the well-known Blue Lick Spring, of Kentucky, which 
is almost identical in composition with the famous Harrogate, of Eng- 
land, may be substituted for the sulphides in many of the cases in 
which the latter are useful. 

The Blue Lick water, like the Harrogate, is useful in abdominal 
plethora. A pint taken before breakfast is an efficient laxative, which 
is indicated in cases of habitual constipation from deficient secretion of 
the intestinal juices. Four ounces taken before each meal is an excel- 
lent remedy for obesity. Engorgement of the pelvic viscera in women, 
haemorrhoids in both sexes, when due to torpor of the portal circula- 
tion, are relieved by the same agent. For these purposes the Blue 
Lick water may be taken for several weeks or even months, but its use 
should be discontinued when anaemia is threatened. In anaemic sub- 
jects, chalybeates and a generous diet should be conjointly adminis- 
tered. The author has observed excellent results from the prolonged 
use of this water in glandidar affections, hepatic, splenic, uterine, and 
of the prostate. 

A succession of common boils, scrofulous and other abscesses, are, 
it is said, made to mature, and the expulsion of the pus is favored by 
the use of the sulphides. When abscesses are threatened, and before 
matter is formed, the sulphides, it is claimed, may cause them to abort. 
Small doses (gr. ss — gr. j) frequently repeated (every hour or two) are 
said to be most effective under these circumstances. 

External Uses of the Sulphides. — A solution of the sulphide of 



224 AGENTS INCREASING WASTE. 

potassium ( 3 ss — § j) is an efficient application in scabies. An extem- 
poraneous sulphide may be made by boiling one part of quicklime and 
two parts of sublimed sulphur in ten parts of water. With this solu- 
tion the parts affected by scabies may be painted over, after preliminary 
cleansing with a warm bath. Sulphur-baths (solution of sulphide of 
potassium in water, as above mentioned) are very excellent applications 
in the chronic forms of psoriasis and eczema. The following formula 
is recommended by Fox in scabies and prurigo : $ Potassii sulphureti, 
5 vi ; sapon. alb., ft>ij ; ol. olivae, Oij ; ol. thymi, 3 ij. M. A milder 
preparation is the following : $ Potassii sulphureti, 3 iij ; sapon. 
moll., 3 j ; aquae calcis, § viij ; alcohol, § ij. M. Or the following : 
^ Potassii sulphureti, § ss ; aquae calcis, § xvj. M. For the relief 
of pityriasis antiparasitic skin-diseases. 

The sulphide of sodium (unofficial) being more stable, is better 
suited for the preparation of sulphurous baths. An artificial sulphur- 
ous water, in imitation of the Bareges, is made as follows : $ Sul- 
phidi sodii, sodae, sodii chloridi, aa § ij. M. Sig. : A sufficient quan- 
tity for one bath. The Pommade de Bareges of the French is consti- 
tuted as follows : $ Sodii sulphureti, sodii carbonat., aa 3 ij ; axungiae, 
I ijss. M. 

Sulphur-baths are frequently employed to favor the elimination of 
lead, in cases of saturnine disease. For this purpose, from three to five 
drachms of sulphide of potassium may be dissolved in sufficient water 
for a bath. A sulphide of lead is formed on the skin ; but that the 
sulphur-bath promotes the elimination of lead by the sweat-glands more 
than a simple warm bath, seems hardly credible. 

The disagreeable odor of the sulphides, in ointment or solution, may, 
it is said, be much modified by the addition of a little oil of anise-seed. 

Authorities referred to : 

Fox, Dr. Tilbury. Skin Diseases : Their Description, Pathology, etc., second Ameri- 
can edition. 

Gubler, Dr. Adolph. Commentaires Therapeutiques du Codex Medicamcntarius, Paris, 
1868, p. 502. 

Lewis, Louis. The Lancet, March 14, 1874, p. 393. 

Macpherson, Dr. John. The Baths and Wells of Europe, London, 18*73. 

Ringer, Dr. Sidney. A Handbook of Therapeutics, New York, 1872, p. 66. 

Trousseau et Pidoux. Traiie de Therapeutique et de Matiere Medicate, vol. ii, p. 
863, et seq. 

SULPHUROUS MINERAL WATERS. 
1. North Amebic a. 

French-Lick Springs. 

West-Baden Springs, Orange County, Indiana. 
Indian Springs, Martin County, Indiana. 

These waters contain carbonates of soda, potassa, magnesia, and 
lime, and chlorides of sodium, potassium, magnesium, and calcium, 



SULPHUROUS WATERS. 225 

and sulphates of soda, magnesia, lime, and potassa. The gases are 
sulphureted hydrogen and carbonic-acid gas. 

Upper Blue-Lick Springs, Nicholas County, Kentucky. 

Lower Blue-Lick Springs, Nicholas County, Kentucky. 

Big-Bone Springs, Boone County, Kentucky. 

Paroquet Springs, Bullitt County, Kentucky. 

These waters are remarkable for the quantity of sulphureted hydro- 
gen which they contain (from 1*02 cubic inch to 3*75). They are rich 
in the chloride of sodium (from 38*700 grains to the pint to 64*567 
grains). They contain also chlorides of potassium, sodium, magnesium, 
and calcium, carbonates of soda, magnesia, iron, and lime, sulphates of 
soda, potassa, and magnesia, and appreciable quantities of iodides and 
bromides. 

Alpena Well, Alpena County, Michigan. 

This water contains the large quantity of 4 '42 cubic inches of sul- 
phureted hydrogen to the pint. The proportion of chloride of sodium 
is small (8*532 grains to the pint). The other ingredients are carbon- 
ates of soda, magnesia, iron, and lime, and sulphate of lime. 

Sharon Springs, Schoharie County, New York. 

Avon Springs, Livingston County, New York. 

Mild sulphureted waters. The principal salt is sulphate of lime, 
which is found in the different springs, ranging from 11*687 grains to 
13*95 grains to the pint (Sharon). 

Yellow-Sulphur Springs, Montgomery County, Virginia. 

The most important constituents of these waters are sulphates of 
lime, magnesia, soda, potassa, and alumina, and carbonates of lime, mag- 
nesia, and iron. The gas is carbonic acid and sulphureted hydrogen. 

Greenbrier White-Sulphur Springs, West Virginia. 

Salt-Sulphur Springs, Monroe County, West Virginia. 

Red-Sulphur Springs, Monroe County, West Virginia. 

These springs are nearly alike as respects the composition of their 
waters. They contain chlorides and sulphates, but their principal con- 
stituents are sulphate of lime, sulphate of soda, and sulphate of mag- 
nesia. The Greenbrier Spring and the Red-Sulphur Spring waters 
contain also a peculiar sulphur compound, in regard to the nature of 
which but little is known. 

2. European. 

Harrogate, Yorkshire, England. Season from May to September. 

These waters contain chlorides of calcium, magnesium, potassium, 
and sodium, carbonic-acid gas, and sulphureted hydrogen. 

Llandrindod, Wales. 

Saline, chalybeate, and sulphur waters ; rich in chlorides, especially 
of sodium. 

Strathpeffer, Ross-shire, Scotland. 

15 



226 AGENTS INCREASING WASTE. 

This is a strong sulphureted water, and contains sulphate of lime, 
carbonate of lime, sulphate of magnesia, and sulphate of soda. 

Moffatt, south of Scotland. 

The waters contain chloride of sodium (28*07), sulphate of soda, 
sulphate of lime, and sulphureted-hydrogen gas. 

Bare*ges, Hautes-Pyrenees. Altitude, 4,000'. Temperature, 86° to 
113° Fahr. Season from July to September. 

"Waters contain sulphide of sodium, sulphate of soda, chloride of 
sodium, etc. 

These waters are used chiefly for bathing the patients, beginning 
with the colder and passing on to the hotter waters. These springs 
have a special celebrity for the treatment of old wounds, diseases of 
bones, and rheumatic and neuralgic affections. 

Cauterets, Hautes-Pyrenees. Altitude, 3,000', but sheltered. Sea- 
son, June to September. Temperature of baths, 98° to 131° Fahr. 

The composition of the waters is similar to that of those of Bareges, 
but it is more stimulating, and contains a good deal of iodine. It is 
especially advised in incipient tuberculosis, bronchial affections, and 
pelvic diseases of women. 

Eaux-Bonnes, Basse-Pyrenees, near Pau. Altitude, 2,000'. 

Waters sulphurous and saline, similar to but not so exciting as those 
of Bareges. This resort is celebrated chiefly for its effects in laryngeal 
diseases and clergyman's sore-throat. 

Challes, Savoy. 

This water, according to Macpherson, is one of the most remarkable 
in Europe, and " is the strongest sulphur-well known." It contains 
iodine and bromine, sulphide of sodium, bromide of sodium, etc. 

Aix-la-Chapelle, Rhenish Prussia. Altitude, 450'. Temperature 
of air during season, mean, 63° Fahr. Season from June to Sep- 
tember. 

According to Liebig's analysis, these waters contain chloride of 
sodium (20 grains), bromide, iodide, and sulphate of sodium, carbon- 
ate of soda (4*9 grains), sulphate of soda (2*1 grains), sulphate of 
potash (1*1 grain), and carbonates of lime, magnesia, strontia, lithia, 
etc. Used by drinking and bathing, and especially in cutaneous 
diseases, rheumatism, syphilis, hepatic disorders, etc. 

Eilseil, Lippe-Schomburg, Northern Germany. 

Neimdorf, Prussian Westphalia. 

These waters contain the sulphates of soda, magnesia, lime, and 
chlorides of calcium and magnesium. They are highly charged with 
carbonic-acid gas and sulphureted hydrogen. They are useful in 
gouty and rheumatic affections, syphilis, skin-diseases, etc. 

Schintznach, Switzerland. Altitude, 1,060'. 

This is a highly-sulphurous water, and is charged with carbonic- 
acid gas and sulphureted hydrogen. It contains sulphate of soda 



IODINE AND IODIDES. 227 

(9.87 grains), sulphates of potash and lime, chlorides of potassium 
and magnesium, and carbonates, etc. 

Weilbach, Nassau. Altitude, 420'. 

These waters contain bicarbonates of soda (3*123 grains), of lithia, 
of baryta, and of strontia, chlorides of sodium and potassium, car- 
bonates of lime and magnesia, etc. The gases are carbonic acid and 
sulphureted hydrogen. 

Therapy of the Sulphur- Waters. — These waters, as a rule, are 
useful in liver-disorders ; they diminish abdominal plethora, and con- 
gestion of the portal circulation. They are indicated in malarial 
affections of the liver and spleen. Rheumatism and gout, tuber miosis 
in its incipiency, chronic poisoning by the metals, etc., are certainly 
benefited by the internal use, and by baths of sulphurous waters. 
Affections of the skin, syphilitic diseases, chronic rheumatic affec- 
tions, etc., are especially forms of disease remediable by these waters, 
used internally and in the form of baths. 

Authorities referred to : 

Braun, Dr. Julius. Systematisches Lehrbuch der Balneotherapie. 

Macpherson, Dr. John. Baths and Wells of Europe. 

Moorman, Dr. J. J. Mineral Springs of North America. 

Valentiner, Dr. Th. Handbuch der allgemeinen und speciellen Balneotherapie. 

Walton, Dr. George E. Mineral Springs of the United JStates and Canada. 



IODINE AND ITS PREPARATIONS. 

Iodum. — lode, Fr. ; Iod, Ger. ; Iodinium, Latin. 

Iodum. — Iodine. In bluish-black crystalline scales, having a me- 
tallic luster ; very slightly soluble in water (1 in 7,000) ; soluble in al- 
cohol (1 in 12), in ether, in a solution of iodide of potassium, and in a 
solution of chloride of sodium. Dose, gr. ss — gr. j. 

Iodoformum. — Iodoform. In yellow crystals, having a saffron- 
odor. Insoluble in water, but soluble in ether, and the fixed and 
volatile oils. May be prescribed in a mixture, containing at least 
twenty times its weight of mucilage to render it properly miscible 
with water. Dose, gr. j — grs. v. 

Liquor Iodi Compositus. — Compound solution of iodine. Iodine, 
5 parts ; iodide of potassium, 10 parts ; distilled water, 85 parts. 
Dose, m, v — in, xx. 

Tinctura Iodi. — Tincture of iodine. Iodine, 8 parts ; alcohol, 92 
parts. Dose, t[[ j — v\ v. 

TJnguentum Iodi. — Iodine ointment. Iodine, 4 parts ; iodide of 
potassium, 1 part ; water, 2 parts ; and benzoinated lard, 93 parts. 

TJnguentum Iodoformi. — Ointment of iodoform. Iodine, 10 parts ; 
benzoinated lard, 90 parts. 

TJnguentum Potassii Iodidi. — Ointment of iodide of potassium. 



228 AGENTS INCREASING WASTE. 

Iodide of potassium, 12 parts ; hyposulphite of sodium, 1 part ; boil- 
ing water, 6 parts ; benzoinated lard, 81 parts. 

Ammonii Iodidnm. — Iodide of ammonium. A white, granular, 
very deliquescent salt, becoming yellowish-brown by exposure. Very 
soluble in water and in alcohol. Dose, grs. ij — grs. x. 

Fotassii Iodiclum. — Iodide of potassium. In white or transparent 
crystals, wholly soluble in water (4 in 3), and in alcohol (1 in 6). 
Dose, grs. v — 3 j. 

Antagonists and Incompatibles. — Iodine is incompatible with 
the mineral acids, the metallic salts, the vegetable alkaloids, etc. The 
chemical antidote is starch, or substances containing it, as flour. These 
should be given freely diffused in water. It should be remembered 
that starch is the antidote to free iodine. As, however, the iodide of 
starch is not devoid of activity, in cases of poisoning by iodine, the 
contents of the stomach should be evacuated. It is obvious that the 
preparations of iodine, taken after a meal consisting of amylaceous 
materials, will have their activity impaired by the formation of the 
iodide of starch, the acid of the stomach freeing the iodine from its 
chemical association. 

Therapeutically, iodine and the iodides are antagonized by all those 
remedies which promote constructive metamorphosis, and by the vaso- 
motor tonics, quinine, digitalis, cold, etc. 

Synergists. — Alkalies, and other remedies which increase waste, 
favor the action of iodine and the iodides. Under some circumstances, 
mercurials are especially synergistic. 

Physiological Actions. — Iodine. — When brought into contact 
with albuminous substances, iodine combines with it and prevents 
putrefactive change. The vapor of iodine, like chlorine, but in a fee- 
bler degree, decomposes sulphureted and phosphureted compounds. 
It is, therefore, justly ranked among the disinfectants. 

Applied to the skin or mucous membrane, iodine, according to the 
extent of the application, is irritant or caustic. It stains the skin yel- 
low, causes a sensation of warmth in small quantity, or of burning in 
larger quantity, and excites a superficial inflammation followed by des- 
quamation. In some subjects the application of iodine-paint causes 
vesication. Pure iodine, kept in contact with the tissues, produces a 
brown and dry eschar. The vapor of iodine is very irritant to the 
broncho-pulmonary mucous membrane, causing cough, spasm of the 
glottis, and increased flow of mucus. 

Iodine has a hot, pungent flavor, and excites a sensation of heat or 
burning in the stomach. In sufficient quantity, it acts as an irritant 
poison, inflames the raucous membrane of the stomach, and causes su- 
perficial eschars. The amount of iodine necessary to produce toxic 
symptoms varies greatly, and the variation depends in part on consti- 
tutional peculiarities, but chiefly on the amount and quality of the 



IODINE AND IODIDES. 229 

food in the stomach. Whether applied to the surface of the skin or 
taken into the stomach, it quickly diffuses into the blood, and enters 
into combination with sodium or potassium, or with both. 

Iodides. — The iodides are among the most diffusible substances. 
They have a bitter, saline, and very disagreeable taste. In a few min- 
utes after being swallowed, the taste of iodide of potassium returns in 
the mouth, and, during a course of this salt, the saliva is constantly 
charged with it. In the stomach, in considerable doses, they produce 
first a cooling sensation, followed by warmth, and even burning. 
They pass into the blood with great rapidity. It is said that the base 
is changed in the blood, and the iodides of ammonium and potassium 
become iodide of sodium. In the blood they probably undergo no fur- 
ther changes, and do not, so far as is known, modify the composition 
of that fluid. At the points of elimination from the free mucous sur- 
faces (nasal, faucial, and bronchial mucous membrane), the chemical 
changes which ensue set free ozone, and the irritation there experi- 
enced is probably in part due to the iodine, separated from its combi- 
nations by the action of that agent (Buchheim). Elimination doubt- 
less takes place by the broncho-pulmonary, faucial, and salivary glands, 
but chiefly by the kidneys. The diffusion of the iodides into and out 
of the blood takes place with such rapidity that in fifteen minutes they 
may be detected in the saliva and in the urine. 

Diverse opinions have been expressed in regard to the influence of 
the iodides over the assimilative functions. By the syphilographers it 
is held that the iodides promote constructive metamorphosis, and that 
a gain in body -weight is a result of their use. This opinion is devel- 
oped in this way : The subjects of syphilis in its constitutional form 
emaciate, and their forces are depressed ; but, when the iodides are 
given them, the virus is eliminated, and the organism at once reacts. In 
the physiological state the iodides increase waste and the elimination 
of the products of waste, and emaciation with a general depression of 
the vital functions ensues, when they are administered for lengthened 
periods. 

Iodism. — Iodine and the iodides, when given in large quantity, 
produce a state termed iodism. The quantity which will set up this 
state of irritation in one subject will affect another but slightly, if at 
all ; in other words, the susceptibility to the iodine impression varies 
greatly in different individuals. Iodism is manifested by general 
malaise and rise of temperature, frontal headache, coryza, lachryma- 
tion, and sometimes inflammatory swelling of the eyelids, a bitter sa- 
line taste in the mouth, soreness of the throat, hoarseness, and difficulty 
of swallowing — phenomena strikingly similar to summer catarrh. In- 
deed, patients who experience these sensations for the first time, sup- 
pose them to be an acute catarrh. Usually the symptoms of iodism 
subside, notwithstanding the dose which caused them may still be 



230 AGENTS INCREASING WASTE. 

taken, or, as it may be expressed, a " tolerance " is established. The 
quantity which at one time may have caused violent iodism will not 
necessarily again do so, although a considerable interval may have 
elapsed. Indeed, it is sometimes difficult to induce iodism in those 
who have become habituated to the use of the iodides in considerable 
medicinal doses. 

An eruption of acne, especially on the face, shoulders, and thighs, is 
a very common result of the internal use of the iodides ; hydroa on 
the face and forehead is an occasional consequence, but eczema is more 
frequent, yet less so than acne, which is usual. 

Wasting of the mammae and of the testes has never been observed 
by the author, although he has used the largest doses of the iodides, 
for long periods. There is no doubt about their antaphrodisiac ef- 
fects, and it has seemed to the author that permanent loss of sexual 
power has resulted from their long-continued use. 

When it is desirable to avoid iodism, large draughts of water should 
be taken during a course of the iodides. As Rosenthal has shown, 
large dilution of the salt hastens elimination, and thus prevents the 
more severe effects of iodism. 

Benedict has experimentally studied the effects of iodine and of 
iodide of potassium on the nervous system. His observations, made 
on frogs, demonstrated that these agents caused paralysis of the heart 
and of the respiration, but there are no facts indicating that on man 
they possess this power. It is true Schule had a case in which such 
symptoms were induced by injecting the sac of a spina bifida with 
tincture of iodine, but the direct and reflex effects of the injection on 
the spinal cord may have had much to do with the result. The nerv- 
ous symptoms which accompany iodism are apparently due solely to 
the increase in the pulse-rate, the elevation of temperature, and the 
irritation of the broncho-pulmonary mucous membrane. 

Therapy. — A weak solution of the iodide of potassium (grs. j — grs. 
v — § j) is a useful application to the mouth in aphthae, mercurial sto- 
matitis, simple sore-throat, tonsillitis, etc. Hypertrophy of the tonsils 
can usually be cured by the injection of the tincture of iodine into 
their substance. To execute this little operation, an hypodermic syr- 
inge, with a sufficiently long needle, is necessary. 

The vomiting of pregnancy can sometimes be greatly relieved by 
drop-doses, every hour or two, of the tincture of iodine. This, like all 
other remedies for this disorder, is very uncertain, and precise indica- 
tions for its use have not hitherto been ascertained. Catarrh of the 
duodenum, catarrh of the biliary ducts, and the jaundice dependent 
thereon, are, after the acuter symptoms have subsided, cured by small 
and frequently-repeated doses of the iodide of ammonium (grs. j — iij 
in water every two, three, or four hours). This is one of the best 
remedies for the first stage of cirrhosis. The efficacy of the iodide is 



IODINE AND IODIDES. 231 

increased by combination with arsenic : ^ Ammonii iodid., 3 j ; liq. 
potassii arsenitis, 3 ss ; tinct. colombae, § ss ; aquae, § jss. M. Sig. : 
A teaspoonful three times a day, before meals. 

The preparations of iodine and the iodides are, generally speaking, 
contraindicated in all inflammatory states of the intestinal canal ; but 
in passive haemorrhage, and diarrhoea from atony of the mucous mem- 
brane, the tincture or compound solution of iodine in small doses — one 
or two drops — frequently repeated, renders important service (Schmidt). 

Large doses (grs. xv — 3 ss) of the iodide of potassium, three or 
four times a day, often afford remarkable relief in aneurism, and 
sometimes effect a cure. This mode of treatment is adapted to in- 
ternal aneurisms so situated as to be beyond the reach of surgical 
means. The author has seen several instances in which great relief 
was experienced, and one case certainly in which a cure apparently re- 
sulted. He is, therefore, able to confirm the observations of Chucker- 
butty, Roberts, Balfour, and others. 

The iodides are unquestionably serviceable in acute catarrh. The 
action is local and substitutive. A grain of the iodide of ammonium 
every two hours has seemed to the author the best mode of applying 
the remedy. In summer catarrh or hay-asthma, the best results are 
obtained by the use of larger doses, and the efficacy of the iodides is 
increased by combination with arsenic. fy Potassii iodidi, § j ; liq. 
potassii arsenitis, 3 j ; aquae, § iv. M. Sig. : A teaspoonful every four 
or six hours. With the internal use of the iodides may be combined 
the local use, to nares and fauces, of the following solution : I> Tinct. 
iodinii, 3 j ; acid, carbol., gtts. x ; aquae destil., \ iv. M. Sig. : Apply 
with a post-nasal syringe. Local applications will be effective, when 
the morbid action is confined to the nares and fauces. 

The iodide of potassium is one of the most effective remedies which 
we possess for spasmodic asthma. But it is not adapted to all cases 
arising under various conditions — a fact which explains the difference 
of opinion on the subject between Williams, Salter, and others. It is 
most beneficial when the asthmatic seizures are induced by an acute 
bronchial catarrh, the nervous symptoms being reflex ; and when there 
occurs during an asthmatic attack profuse bronchial secretion. Salter, 
however, holds that we possess no exact indications for its use, and 
that cases the most diverse are sometimes benefited in a remarkable 
manner. As regards dosage, from fifteen to thirty grains every two, 
three, or four hours, according to the severity of the seizure, is usually 
the necessary quantity. 

Chronic bronchitis, with profuse secretions (bronchorrhcea), is fre. 
quently improved by the iodides, more especially the iodide of am- 
monium. The efficacy of this remedy is increased by the conjoined 
administration of arsenic. In capillary bronchitis, the author has 
witnessed most astonishing relief by the rapid administration of iodide 



232 AGENTS INCREASING WASTE. 

of ammonium in small doses. It may be combined with the carbon- 
ate, or with the stimulant expectorants. To prevent caseation of the 
inflammatory exudations of catarrhal and fibrinous pneumonia, no 
remedy is more efficient than the iodide of ammonium. To lessen the 
effect of this remedy on the tissue-changes, arsenic should be combined 
with it, and every means used to support the body nutrition. The 
iodide of potassium is one of the remedies resorted to in chronic pleu- 
risy, to promote absorption of effusions. In these cases the chest is 
painted with the tincture, and the iodides are administered steadily 
for a considerable period. 

Affections of the broncho-pulmonary mucous membrane, alluded 
to above, in which there is profuse exudation, all inflammatory symp- 
toms having subsided, are advantageously treated by iodine inhala- 
tions. The method which the author has found most convenient is the 
following : A small, wide-mouthed bottle, containing a moistened 
sponge, is placed in a vessel of hot water. The tincture of iodine 
(gtts. v — gtts. x) is dropped upon the sponge, and as the vapor of 
iodine rises, is inhaled with the vapor of water. This inhalation is 
serviceable in acute catarrh, hay -asthma, and chronic bronchitis. The 
carbolate of iodine (tinct. iodinii, 3 ij ; acid, carbol., 3 j) may be used 
instead of the simple tincture of iodine. Ten to twenty drops for in- 
halation. 

But few affections of the brain, non-specific in origin, are benefited 
by the iodides. According to Niemeyer, the iodide of potassium given 
to iodism has in few instances cured basilar meningitis. The author, 
who has used it faithfully in various cases, has not been so successful. 
Trousseau et Pidoux express their disbelief in the reported cures of 
tubercular meningitis by this agent. Seguin maintains, on the other 
hand, that remarkably good results sometimes follow the use of large 
doses of the iodides in other than specific diseases — in the various sub- 
acute and chronic inflammatory affections of the meninges and brain. 

No remedy is more efficient in the treatment of certain glandular 
enlargements of the thyroid, spleen, and lymphatic glands. Goitre is 
curable by the internal and external application of iodine, when it con- 
sists of simple hypertrophy of the gland-elements. Cystic and calca- 
reous degeneration of the thyroid are unaffected by the use of iodine 
preparations never so vigorously used. One of the best remedies for 
true goitre, as will be seen hereafter, is the unguentum hydrarg. iodidi 
rubri. Enlarged spleen, when it consists merely of an hypertrophy of 
the organ (chronic splenitis), is cured by the internal use of the iodides 
conjoined with the local use of iodine-paint, or ointment of the red 
iodide of mercury. The enlargements of the spleen and liver, with 
functional derangement of these organs, which are caused by malarial 
disease, are most effectually removed by moderate doses, frequently 
repeated, of the iodide of ammonium. The author's experience jus- 



IODINE AND IODIDES. 233 

tifies him in strongly urging the combined use of iodide of ammonium 
and arsenic in chronic malaricd poisoning . 

The prolonged administration of iodide of potassium has appeared 
in some instances to have retarded the changes which ensue in chronic 
Bright s disease (fibroid degeneration), and to have improved the con- 
dition of the patients. 

The utility of the iodides is most conspicuous in certain constitu- 
tional states. The expectations which were at first entertained of the 
cure of scrofula by iodine and its preparations have not been realized. 
The iodides are unquestionably useful in the scrofulous (so called) 
enlargements of the lymphatic glands, but cod-liver oil and suitable 
hygienic means are more influential in improving the strumous di- 
athesis. The preparations of iodine are effective only when simple 
hypertrophy of the lymphatic glands has taken place ; if they have 
undergone caseation, or have proceeded to suppuration, no medicine 
has any influence over them. 

The most important therapeutical applications of the preparations 
of iodine are in the treatment of constitutional syphilis. For the pri- 
mary and secondary stage, mercury is generally admitted to be best ; 
but for tertiary symptoms no remedy at all approaches the iodide of 
potassium. In the secondary affections of the skin, mercury, especially 
if it have not been given for the primary troubles, is to be preferred 
in the papular, tubercular, squamous, and pustular syphilides ; iodide 
of potassium in the ulcerating, especially if the patient is cachectic. 
It may be stated in general that the preparations of iodine are indi- 
cated when the patient is under the mercurial cachexia. On the other 
hand, it is well known that sometimes, even when the tertiary symp- 
toms have not been relieved by a thorough course of iodides, mercury 
will quickly remove them. But this fact does not invalidate the rule 
that the iodides are specially serviceable for the tertiary period. 

No therapeutical fact is more conspicuous than the cure of syphi- 
loma of the nervous system by iodides. Mental disorders, epileptiform 
seizures, paralytic states, etc., dependent on gummata, nodes, etc., are 
usually removed in a manner little short of magical. Neuralgia of the 
fifth (tic-doidoureux), the pain being nocturnal chiefly, or nocturnal 
pain in the head, is similarly promptly cured. In syphilitic affections 
of the brain, more imperatively than in the same affections of other 
organs, are large doses of the iodide of potassium required. The limi- 
tation of the dose depends entirely on the physiological susceptibility 
of the patient, and the influence exerted over the progress of the case. 
Hence the dose may vary from ten grains to a drachm every four hours, 
or three or four times a day. The symptoms of iodism — the use of the 
agent to saturation — should be induced ; for this effect is the only 
measure of the therapeutical power of the remedy. The more promptly 
iodism can be induced, the better, for the soft nervous tissue may 



234 AGENTS INCREASING WASTE. 

be quickly and irreparably damaged by syphilitic deposits and new 
growths. Syphilitic paraplegia is equally amenable to the same 
means ; but, as above remarked, much depends on the promptness 
with which the iodide is used. 

Recent experience has conclusively shown the curative power of 
iodine in malarial fevers. Thus three hundred consecutive cases were, 
with few exceptions, promptly arrested (Anderson). In some cases no 
paroxysm occurred after the medicine was administered ; sometimes 
the attacks persisted for two or three days, but then the relief was 
complete. The official compound tincture of iodine may be prescribed 
— for adults, ten to fifteen minims, three times a day, well diluted, and 
before meals. Carbolic acid, itself having considerable anti-periodic 
power, may be combined with the compound tincture of iodine. $ 
Tinct. iodinii comp., § ij ; acid, carbolic, 3 j. M. Sig. : Ten to fifteen 
minims three or four times a day. The official tincture of iodine is 
given by many practitioners. If quinine be necessary to break up the 
paroxysms, iodine is highly useful in the interim, as has been indi- 
cated. Some recent experiences by Dr. Atkinson, of Baltimore, throw 
doubts on the previous statements. He found that iodine failed in 
two thirds of the cases of intermittent fever. 

The use of the compound solution of iodine during the course of 
the first and second week of typhoid fever is known in Germany as 
the " specific treatment.'' A very considerable reduction in mortality 
appears to have followed this method. The solution of iodine or the 
tincture is administered regularly three times a day, well diluted with 
water. When it does good, the temperature falls, the nausea lessens, 
and the diarrhoea is restrained within safe limits. 

Chronic rheumatism, when there are present thickening of the 
fibrous tissues, and inflammatory depositions about joints, tendons, peri- 
osteum, and nerve-trunks, is often very signally benefited by the iodides. 
The cases in which these remedies prove so serviceable are most prob- 
ably due to syphilitic, mercurial, saturnine, or other constitutional 
causes. There are, in our modern life, many ways in which these 
mineral poisons enter the organism, and it is probable that they are 
often undiscovered and even unsuspected causes of rheumatic symp- 
toms. Jjambago, sciatica, and paraplegia, apparently of rheumatic 
origin, and curable by the iodides, may not unfrequently be caused by 
syphilis, mercury, copper, tin, or lead. 

The various accidents caused by the metals above named, especially 
the mercurial and saturnine, are removed by the use of the iodides, 
notably by the iodide of potassium. With regard to the dose neces- 
sary, what is true of syphilis is equally true of the mineral poisons : in 
order to remove them, the organism must be saturated by the remedy. 
From fifteen grains to a drachm, three or four times a day, should be 
given ; but the measure of the quantity required is the effect pro- 



IODINE AND IODIDES. 235 

duced. The iodides penetrate into every tissue, convert the deposited 
metal into soluble combinations, and cause them to be discharged by 
the various organs of excretion, chiefly by the kidneys. It has been 
repeatedly asserted that salivation may be induced, and existing sali- 
vation increased, by the use of the iodides for the removal of mercu- 
rial salts from the organism ; but the author has not witnessed any 
facts which support this statement. 

In skin-diseases of syphilitic origin there can be no question as to 
the utility of the iodides. But these remedies are more especially cura- 
tive in the tertiary affections, especially in destructive syphilitic ulcera- 
tions. Hebra insists, and with justice, that the preparations of iodine 
are only useful in lupus, whether syphilitic or scrofulous, and do not 
permanently improve other cutaneous diseases. Mr. Hutchison calls 
attention to the fact that the various skin-diseases classed as hydroa 
may be produced by the iodide of potassium. The author lias cer- 
tainly had one case illustrating this action of the iodide. 

Local Uses of the Preparations of Iodine. — The tincture of 
iodine is in universal use as a counter-irritant. It is applied by means 
of a camel's-hair brush to goitre, to enlarged glands, and to superficial 
inflammatory swellings before the formation of pus. Painted over the 
neck, it is a useful counter-irritant in acute affections of the pharynx 
and larynx, and to the chest to relieve the chest-pains which occur in 
phthisis. It is the most serviceable counter-irritant to promote absorp- 
tion of inflammatory products in catarrhal and fibrinous pneumonia 
after the acuter symptoms have subsided. The same application ap- 
pears to possess the power to promote the absorption of pleuritic effu- 
sion. It is a good plan in these affections to paint, on successive days, 
the tincture over the front, the lateral, and the posterior wall of the 
chest, so that one surface has time to recover from the irritation before 
it is again attacked. As the susceptibility to the action of the iodine 
varies in different subjects, it is always prudent to make a slight appli- 
cation in the beginning. If extreme burning follow the applications, 
the iodine may be dissolved off by a solution of iodide of potassium, 
by alcohol, or ether. 

The tincture and the ointments of iodine are also used to remove 
the induration of the breasts which results from attacks of inflamma- 
tion. It must be remembered that the integument in this situation is 
extremely sensitive to irritating applications. Splenic and hepatic dis- 
orders of a chronic kind are frequently treated locally by the a])plica- 
tion of tincture and ointment of iodine. Enlarged spleen of malarial 
origin is more speedily cured by the application of the official red 
iodide-of-mercury ointment, and, as regards hepatic disorders, the only 
affection which has seemed to the author to be benefited by iodine ap- 
plications is the engorgement due to malarial attacks. 

After the acute symptoms have subsided, tincture of iodine will re- 



236 AGENTS INCREASING WASTE. 

move the swelling of orchitis. The scrotum, like the female breast, is 
very sensitive to the irritation of iodine tincture and ointments. Bubo, 
like the enlarged lymphatic glands in other situations, may be treated 
by the application of iodine-tincture, but it is not very effective. 

Although Hebra does not approve of the internal use of iodine in 
cutaneous diseases, he advises the local application. He employs the 
tincture or glycerine solution in chloasma, lentigo, and lupus. The 
tincture of iodine is used to prevent the pitting of smallpox. Accord- 
ing to Piringer, it should be applied as follows : If on the first day of 
the eruption, the whole face, including the eyelids, is brushed over with 
the tincture of iodine ten times, there being an interval of a half -hour 
between each application ; if on the second day, twelve applications ; 
if on the third day, twelve to sixteen applications. The tincture of 
iodine is sometimes painted over the affected surface in erysipelas, and 
over the surrounding healthy integument, to prevent the spread of the 
disease, but, according to the author's experience, it is bad practice. 

Iodoform may be substituted for iodine in the form of the official 
ointment. This may be used locally, rubbed in, as the iodine-oint- 
ments are, for the relief of local inflammatory swellings, enlarged lym- 
phatic glands, goitre, etc. The strong, diffusive, and peculiar odor of 
iodoform is an objection to its use in this way. Iodoform powdered 
and dusted over the diseased surface is an excellent application to 
sloughing and ill-continued wounds, irritable ulcers, rodent ulcer, chan- 
croid, sloughing phagedena, and serpiginous syphilitic idcers. It allays 
pain, changes the morbid action, and is antiseptic. Syphilitic idcers 
of the tonsils, pharynx, and tongue, are most effectually treated by local 
and direct application of powdered iodoform. In these cases the pow- 
der may be blown on to the surface of the ulcer by an insufflator or 
insufflation-tube. Fissures of the anus, haemorrhoids and idcers of 
the rectum, are improved in condition, and the pain which attends them 
relieved by application of the ointment of iodoform and by iodoform 
suppositories. The latter are also of undoubted service in chronic 
metritis and hypertrophy of the prostate when introduced into the 
rectum ; the iodoform diffuses into the neighboring organs, and acts 
directly upon them. The pain of cancer may be somewhat relieved, 
and the fetid odor which attends the discharges may be removed, by 
the application of iodoform to the diseased surface. This treatment 
may be applied to cancer in any situation, but is especially applicable 
to cancer of the uterus and rectum. 

The parenchymatous injection of tincture of iodine is a remedial 
means of great importance. The method of employing it is exceeding- 
ly simple. An ordinary hypodermatic syringe (glass or hard rubber) 
is charged with five to fifteen minims or more of the tincture, and the 
needle is thrust deeply into the affected tissue, and the iodine is slowly 
discharged. For injection into parts very deeply situated, long needles, 



IODINE AND IODIDES. 237 

such as are made for aspiration, can be used. This method of treat- 
ment is very effective in hypertrophied tonsils, goitre, glandular tumors, 
and the compound cystic and glandular growths so frequently found in 
the neck. The author has witnessed the cure of many cases of this 
kind by the parenchymatous injection of tincture of iodine. Some 
precautions must be attended to in practicing these injections. When 
the point of the needle is inserted as deeply as desired, it should be 
moved about to disengage it from any vessels into which it may have 
penetrated. The injection should be practiced slowly, to give time 
for the tincture to diffuse into the substance of the tumor. It need 
hardly be remarked that the superficial vessels of the neck should be 
avoided in inserting the needle. 

When hydrothorax returns after evacuation of the cavity by the 
trocar, the compound solution of iodine or the tincture may be injected 
into the pleural sac. In empyema, the undiluted tincture of iodine 
may be thrown in without risk, and with great benefit. Ordinarily, 
a solution of the following strength may be used to wash out the cav- 
ity in cases of empyema : I> Liq. iodinii comp., § j ; aquae, § xv. M. 

Hydatids of the liver may easily be destroyed by injecting into 
them a few drops of tincture of iodine. It has, however, been shown 
that in some instances simple capillary puncture and withdrawal of the 
fluid suffice to arrest the growth and to abort these parasites. Injec- 
tion of tincture of iodine is one of the means resorted to to cure hy- 
drocele. 

It is said that hypertropliied prostate may be diminished and fur- 
ther enlargement prevented by parenchymatous injection of iodine. 
In the performance of this operation a Sims or bivalve rectal speculum 
is inserted, and the needle of the syringe is passed through the walls 
of the rectum into the gland. Careful palpation previous to the inser- 
tion of the needle, will enable the operator to avoid important vessels. 

Unilocidar ovarian cysts may sometimes be cured by injecting into 
them, after the withdrawal of the fluid, ten to sixteen ounces of tinc- 
ture of iodine. No other form of ovarian cyst will, however, be affected 
favorably by this expedient. 

Large abscesses may be made to close much more speedily than they 
would otherwise, and septic infection be prevented, by the injection of 
iodine-tincture after the evacuation of the matter. 

Numerous cases of spina bifida have been cured by the injection 
into the sac of tincture of iodine ( 3 ss) or a solution of iodine (gr. ss) 
and iodide of potassium (gr. v) in water ( 3 j). 

Io do- Tannin.- — This is an excellent application for local diseases. 
Tannin may be dissolved to saturation in tincture of iodine, or an aque- 
ous solution may be prepared as follows : £> Iodinii, 3 j ; acid, tannici, 
| j; aquae, Oj. After filtration to be evaporated to f iv. 

The author has found a saturated solution of tannin in tincture of 



238 AGENTS INCREASING WASTE. 

iodine a most efficient application in all those cases of uterine disease 
in which the tincture of iodine and iodized cotton and iodized glycerin 
are now so much used. It is serviceable in chronic cervicitis, chronic 
endo-rnetritis, sub-involution and hypertrophy of the uterus. The au- 
thor has also found that the following combination is a capital applica- 
tion in leucorrhoea and the above-named uterine affections : IJ Iodo- 
formi, 3 ]* ; acid, tannici, § j. M. A sufficient quantity to be packed 
in the dry state around the cervix. 

The iodide of starch is used by Mr. Marshall as a dressing for syphi- 
litic ulcers, and he speaks highly of its efficacy. 

A decolorized tincture of iodine for external use may be prepared 
as follows : iodine, hyposulphite of sodium, distilled water, of each ten 
parts. Dissolve with a moderate heat, and add sixteen parts of spirits 
ammonia, and, after a few minutes' agitation, add seventy-five parts of 
alcohol. The solution must stand in a cool place for three days, and 
then be filtered (Waldenburg und Simon). Decolorized iodine is of 
doubtful utility. 

An extemporaneous iodo-tannin may be prepared according to the 
formula of Sigmund : ^ Tinct. iodinii, tinct. gallae, aa § ss. M. The 
strength of this may be increased by the addition of iodine 3ij. 

Ethee Hydeiodicus. — Iodide of ethyl. Ethyl-iodide. 

This is a colorless, non-inflammable liquid. The odor is peculiar, 
very powerful and diffusible, and the taste pungent. It is not solu- 
ble in water, but dissolves to some extent in alcohol. Its specific grav- 
ity is 1*92, and its boiling-point 160° Fahr. Exposed to light and air 
it assumes a dirty, brownish-yellow color, from the setting free of 
iodine ; hence it should be kept in closely-stoppered bottles in the 
dark. The dose is fifteen to twenty drops inhaled from a handker- 
chief, three or four times a day. 

Physiological Actions. — Although ethyl-iodide might be classi- 
fied with the other anaesthetic agents, its physiological and therapeuti- 
cal effects ally it more nearly to the iodides. As an anaesthetic, the 
action is slow and imperfect. Dr. Lawrence, of Boston, testing the 
action in his own person, found that a half -hour of inhalation failed to 
produce even drowsiness. It is said, however, that it induces the anaes- 
thetic state in animals, but further information is needed on this point. 

Hydriodic ether offers a ready and effective means for introduc- 
ing iodine in the system. M. Huette first employed it for this pur- 
pose, and his observations were afterward confirmed by Mr. Turnbull, 
of Liverpool. Then Dr. Fisher, of New York, also used it with the 
same object. Probably, the most satisfactory observations which 
have been made are those of Dr. Lawrence, of Boston, who not only 
studied the physiological action of this ether, but indicated the mala- 
dies in which it is useful. 



IODINE AND IODIDES. 239 

Therapy. — Ethyl iodide is administered by the broncho-pulmonary 
mucous membrane. Fifteen to twenty drops are put on a handkerchief 
and inhaled as may be necessary — every two, three, or four hours, or 
more or less frequently. As a means of introducing iodine into the 
blood, it offers many advantages. When, therefore, it is necessary to 
induce iodism speedily, as in syphiloma of the brain or spinal cord, 
it is an appropriate remedy. In the spasmodic affections — the neu- 
roses of the respiratory organs — as asthma, emphysema, whooping- 
cough, etc., when accompanied by catarrh of the mucous membrane 
especially, excellent results may be expected from the inhalations. 
Dr. Lawrence has found it of exceptional utility in asthma. Good 
effects maybe had from it in capillary bronchitis, in chronic bronchitis, 
in fibroid phthisis, and in caseous phthisis. 

Iodoformum. — Iodoform. — Iodide of formyl. Small, lemon-yellow, 
lustrous crystals of the hexagonal system, having a saffron-like and 
almost insuppressible odor, and an unpleasant, slightly sweetish iodine- 
like taste. Not perceptibly soluble in water, to which it imparts a 
slight odor and taste ; soluble in 80 parts of alcohol at 15° C. (59° 
Fahr.) and in 12 parts of boiling alcohol, in 5*2 parts of ether, and in 
chloroform, benzol, benzin, disulphide of carbon, fixed or volatile oils. 
It sublimes slightly at ordinary temperatures. (U. S. P.) 

Unguentum lodoformi. — Iodoform ointment. Iodoform, 10 parts, 
benzoinated lard, 90 parts. 

Actions and Uses. Notwithstanding iodoform contains 97 per 
cent of iodine, it possesses properties in some respects different from 
that agent. Discovered by Serullas in 1822, it was not prescribed 
until 1836, when Bouchardat used it because of the large quantity of 
iodine contained in it. In 1853 D'Olleggio brought it forward as a 
disinfectant and deodorizer ; and in 1856 MM. Moretin et Humbert 
showed it might be substituted for the iodides, because easily absorbed 
and free from any irritant properties. They also demonstrated that 
iodoform has anodyne effects, that it induces analgesia of the rectum 
when applied to it, and that it can be used in the same classes of dis- 
ease as iodine, and in some neuralgias and painful affections of the 
bladder and prostate. In 1866 Dr. Eastlake, in the course of a paper 
on uterine therapeutics, referred to iodoform as a valuable sedative in 
uterine cases. Dr. Greenhalgh soon after confirmed these observa- 
tions. The following year, Yoelker added some new facts of the 
same kind. In 1868 Fereol, in a paper read before the Therapeutical 
Society, gave full details regarding the effects of iodoform on wounds, 
fully anticipating many of the observations since made on its antiseptic 
and healing^properties. 

Little attention had been given to iodoform in Germany, before 
the investigation made by Binz. Moleschott followed these researches 



240 AGENTS INCREASING WASTE. 

by some important chemical observations, and afterward Mosetig and 
Mikulicz, of Vienna, and Gussenbauer, of Prague, set forth the remark- 
able virtues of this substance as an antiseptic dressing. Since these 
communications appeared, the use of iodoform has received enormous 
extension, and its popularity has attained to such extravagant propor- 
tions, that the wide-spread enthusiasm may be entitled iodoform-mania. 
There can be no question, however, as to its utility. There are, never- 
theless, limitations to its employment, imposed by' the nature of the 
substance. It seems desirable, hence, to set forth in a special article its 
actions and uses, according to the modern conceptions of its powers. 

As iodoform contains 97 per cent of iodine, it may be supposed to 
have analogous properties, but, as the iodine is combined with the radi- 
cal formyl, another influence enters into the action. Applied in the 
form of crystals or as a powder, the immediate effect is that of the 
compound — iodide of formyl — and not that of iodine merely, or of 
formyl merely ; but the latter distinctly modifies the former ; hence 
there is more or less of an anodyne effect. Binz holds that when iodo- 
form is applied to a wound it is dissolved in the fatty bodies of the 
organism, and that iodine is disengaged to form iodides and iodates. 
Hogyes, on the contrary, maintains that the iodine when set free unites 
with albumen', and afterward forms salts. Moleschott explains the 
more energetic action of iodoform by the assumption that it is readily 
decomposed in the blood, and that the free iodine in its nascent form 
has more energetic affinities (Rohmer). In what manner soever its 
mode of action may be explained, the main point, in regard to which 
all are agreed, is, that the action of iodoform is chiefly due to the io- 
dine. The effects of iodine have already been set forth, and hence no 
further statements are necessary ; but the antiseptic action of iodoform, 
to which its present applications are chiefly due, requires further ex- 
position. Mikulicz has especially studied the effect of iodoform on 
decomposing animal substances, and he finds that it prevents change 
and arrests decomposition when begun. For the purpose of determin- 
ing its power to prevent putrefaction, he employed Pasteur's liquid, 
composed of extracts of foods, of malt, of peptones, of alkaline urine, 
and of bouillon, and blood, and covered this mixed solution with pow- 
der and crystals of iodoform. The experiment was varied by adding 
iodoform in different quantity to solutions having the same composi- 
tion, and a " control experiment " was employed, to verify the results. 
It was shown that, in those solutions treated with sufficient iodoform, 
there was absolutely no development of minute organisms, while in 
the " control " fluid the germs were abundant and the putrefactive 
process active. In contact with wounds it has a very prompt and 
thorough antiseptic action. It promotes union and cicatrization, and 
at no time are there any heat, redness, swelling, or pain produced by 
it at the point of application. There is very little secretion from the 



IODINE AND IODIDES. 241 

wound treated by the application of iodoform, and the little observed 
has rather a serous than a purulent character. When a considerable 
loss of substance is to be closed by granulations, iodoform does not 
act so well, it is said, and hence, when the granulations have filled the 
wound up to the level of the skin, it is better to substitute solutions of 
nitrate of silver, of acetate of lead, etc. 

Notwithstanding iodoform acts in many respects like iodine, there 
are differences. When the iodides or iodine tincture are given in suf- 
ficient doses, among the phenomena of iodism caused are coryza, 
pharyngeal and laryngeal catarrh, etc., and there ensues very consid- 
erable wasting of the tissues in general. On the other hand, when 
iodoform is given, wasting does not occur, but the body-weight in- 
creases, the complexion grows better, and the general condition im- 
proves in every way (Rohmer). It can not be affirmed, the author 
believes, that these beneficial results are constant for all doses of the 
remedy administered by the stomach, or for all quantity when applied 
topically. In fact, the first enthusiasm awakened by the discovery of 
the antiseptic powers of iodoform has been chilled by the untoward 
results of too lavish application. Not only dusted over the wounded 
surface, but applied in thick layers, it was soon found that, notwith- 
standing the slow absorption of iodoform, sufficient entered the blood 
to produce alarming, serious, even fatal symptoms. 

Poisoning by Iodoform. — It is very important to have a clear con- 
ception of the mischief which may be thus caused. As iodoform will 
probably continue to have an important place in the antiseptic method 
of surgical dressings, and as it is also much employed in medical prac- 
tice, the practitioner should learn to recognize the untoward symptoms. 
"Eseter, of Trieste," says Louguet, "had a case of death from the 
iodoform-mania." But many deaths have since followed from the too 
lavish use of this agent. An idiosyncrasy is observed in some subjects 
— a special susceptibility to the action of the iodides in general, and 
to iodoform in especial. It sometimes happens that this idiosyncrasy 
develops suddenly and without warning, and the toxic symptoms oc- 
cur at once, death quickly ensuing, although the remedy is suspended 
(Schede). When the action of iodoform is unfavorable, the symptoms 
observed have been as follows : 1. Rise of temperature to 104° Fahr., 
or even higher. 2. In addition to fever, there will be headache, loss 
of appetite, a rapid pulse, low tension of the vessels, etc., but the 
symptoms in both classes will quickly disappear if the remedy is dis- 
continued. 3. In this form of iodoform-poisoning, the pulse is quick, 
reaching even 180, and is feeble; there is much depression of the forces 
in general, and the condition of the mind is anxious, restless, and 
melancholic. These symptoms may be caused in some subjects by the 
first application of iodoform, or may come on after an apparent toler- 
ance has been established. 4. In this group of toxic cases, the same 
16 



242 AGENTS INCREASING WASTE. 

symptoms occur as in the third, viz., high fever, melancholia, etc., but 
the termination is quickly fatal, although the application of the rem- 
edy is stopped. 5. In this group, the symptoms of a profound depres- 
sion come on, and death speedily occurs in a condition of collapse. 
In many examples of this kind, it may well be a question whether 
this accident is not due to the injury of operative procedures. 6. In the 
more formidable results of iodoform applications, very decided cere- 
bral symptoms have been observed. These have been described by 
Schede and Kiister more especially, and are mentioned by them in 
connection with the several classes of iodoform-poisoning above re- 
ferred to. There is, however, a condition of the cerebrum caused by 
iodoform-poisoning characterized by disordered stomach, high fever, 
dilated pupils, melancholic depression, stupidity of mind, involuntary 
evacuations, hallucinations, etc. 

Notwithstanding the above-described forms of poisoning have a 
real existence, it is held by Mundy, Czerny, Kiister, and others, that 
now and then, probably frequently, a septicaemic state, and undiscov- 
ered complications, are responsible for the symptoms attributed to 
iodoform. Making due allowance for such an error, there are still 
examples of the toxic effects of iodoform ; hence the need of proper 
caution in using it topically. 

Treatment of Iodoform Intoxication. — The first step consists in 
the withdrawal of the application, and every adherent particle should 
be at once removed. The powers of life should be supported by a 
judicious use of stimulants, and especially by small doses of the tinc- 
ture of opium, frequently repeated. Elimination should be promoted 
by diluents freely administered. 

The most important point as regards prophylaxis is to avoid too 
lavish use of the agent. Schede says that large flesh-wounds should 
not be filled with iodoform, for then it can be removed only with the 
scab. Granulating surfaces absorb less, but here the danger of in- 
toxication also exists. Mundy advises that a small quantity only of 
the powder be dusted over the wound, that the dressings be allowed 
to remain, and that close sutures and tight bandages be avoided. It 
appears that caution is needed in the application to the amputated 
breast, and in all operations involving the peritonaeum. As to quantity 
used, we are guided by the results following lavish use. Three hun- 
dred grammes in one case (Beger), 100 to 200 grammes (Henri) in 
another, have induced poisoning. Death followed the use of 35 to 40 
grammes (542 to 620 grains) in a case of operation involving the peri- 
tonaeum (Kiister). 

Von Mosetig-Moorhof has employed iodoform in several thousands 
of surgical cases without a single instance of poisoning, and he attrib- 
utes this favorable result to the fact that he has not used large quanti- 
ties of the remedy, thai the wound was not subjected to pressure, that 



IODINE AND IODIDES. 243 

the dressings were frequently changed, and that carbolic acid was not 
used at the same time. 

Mode of applying Iodoform. — The simplest mode consists in 
merely dusting the powder over the surface, wound, or sore, to be 
acted on. A common tin pepper-box or an insufflator may be utilized 
for this purpose. Gauze or absorbent cotton may be saturated with 
an ethereal saturated solution of iodoform and applied according to the 
methods of Lister. Iodoform and tannin may be applied in any de- 
sired proportion after they have been thoroughly triturated together. 
Iodoform may also be suspended in a mixture with gum — with glycer- 
in and gum-tragacanth. As the odor of this substance is so diffusive 
and persistent, various means have been resorted to for its removal or 
modification. The essential oils, the balsams of Peru and tolu, es- 
sences of all kinds, menthol, eucalyptol, and thymol, have been employed 
with varying success ; of these, thymol appears to be the best, for, 
while it modifies the odor, it less impairs the antiseptic qualities. The 
mixture of iodoform and thymol may be in any desired proportion. 
Lindemann advises the following mixture : Iodoform, 1 part ; balsam 
of Peru, 3 parts ; and vaseline, 8 parts : or iodoform, 1 part ; balsam of 
Peru, 3 parts ; alcohol, glycerin, or collodion, 12 parts. So numerous, 
indeed, are the modes of applying the remedy, that it would be quite 
impracticable to name them all. 

Applications. — In' general it may be stated that iodoform is now 
used in all the wounds, injuries, diseases, requiring the action of an 
antiseptic. Chancres, ulcers, sloughing and phagedenic ulcers, surgical 
operations, etc., are especially benefited by its application. It is, above 
all topical remedies, the most appropriate for gunshot wounds and in- 
juries (Mundy). As an antiseptic remedy, applied according to the 
principles of Lasterism, it is no doubt the best remedy thus far pro- 
posed to prevent decomposition, and to destroy the germs of disease 
and of putrefaction. The first enthusiasm awakened by it degenerated 
into an " iodoform-mania," and doubtless much mischief was caused 
by it ; but, now that the enormous experience in its use can be properly 
analyzed, more exact rules for its application can be formulated, and 
its real place in the antiseptic method can be clearly ascertained. 

Authorities referred to for iodoform and ethyl-iodide : 

Binz, Prof. Dr. C. Ueber Iodoform und uber Iodsaiire. ArcJiiv fur experiment. 
Pathologie und Pharmacologic, Band viii, p. 309. 

Hogyes, Prof. Andreas. Anmerkungen uber die physiologische Wirkung des Iodo- 
form und uber seine Umwandlung im Organismus. Archiv fur experiment. Pathologie und 
Pharmacologic, Band x, p. 228. 

Kuster, Prof. Dr. Revue de Chirurgie, 1882, and L 1 Union Medicale, August, 1882. 

Lawrence, Dr. New York Medical Journal, 1881, p. 685. 

Lintjemann, Dr. Annuaire de Titer apcutique, 1881, p. 269. 

Longuet, Dr. R. Le Proces de VIodoformc. X' Union Medicale, No. 108, 1882. 



244 AGENTS INCREASING WASTE. 

Mikulicz, Prof. Dr. Wiener med. Wochenschrift, quoted by Revue de Chirurgie, 
No. 7, 1882, p. 579. 

Moleschott, Prof. Dr. Ibid. 

Mosetig-Moorhof, Prof. Dr. Yon. Ibid. 

Mundy, Prof. Dr. Berliner klin. Wochenschrift, No. 14, 1882, quoted by L 1 Union 
Med., No. 125, 1882, p. 439. 

Rohmer, Dr. Du Pansement d VIodoforme. Revue de Chirurgie, 1882. 

Sands, Dr. H. B. New York Medical Journal, November 12, 1882. 

Schede, Prof. Dr. Deut. med. Zeit., quoted by the London Medical Record, July 15, 
1882. 

[The literature of iodoform is now so immense, that to refer to it all would take up 
too much space. The above references are to papers of the most use to the author in 
preparing this article.] 

Authorities referred to for iodine and the iodides : 

Bellini, of Florence, and Reinzi, of Naples. Controversy on the Action of Iodine, 
reported in L Union Medicale, No. 20, p. 481. 

Benedict, Dr. Moriz. Schmidt's Jahrbucher der gesammten Medicin, vol. cxv, p. 284. 

Binz, Prof. Dr. C. Archiv fur pathologische Anatomie und Rhys., Virchow's Archiv, 
Berlin, 1874, p. 124. 

Frankel, Dr. B. Berliner Jclinische Wochenschrift, ix, 6, 1872. 

Gubler, Dr. A. Commentaires Therapeutiques du Codex Med., pp. 412, 527. 

Hebra, Prof. Von. Allg. Wien. med.Zeitg., vii, 3, 1862. Schmidt's Jahrbucher, vol. 
cxvii, p. 26. 

Hermann, Dr. Jos. Die Nichtexistenz des constituiionellen lodismus. Schmidts Jahr- 
bucher, vol. cxii, p. 19. 

Hutchison, Mr. Jonathan. Lancet, May 22, 1875, p. 725. 

Izaud, Dr. A. A. Nouveau Traite de la Malad. Ven. et dcs Syph. Ulcereuses par 
VIodoforme, Paris, 1871. 

Kammerer, Prof. Dr. Hermann. Archiv fur path. Anat. und Rhys., von Rudolph 
Virchow, 1874, p. 459. The article of Binz, above referred to, was instigated by this 
paper. 

Rabuteau, Dr. Gazette de Paris, 14, 1869. Schmidts Jahrbucher ', vol. cxliv, p. 28. 
Ibid., vol. cxlv, p. 272. 

Rosenthal, Prof. Dr. Zur Kenntniss der Resorption und Absorption der lodprdpa- 
rate. Wien. med. Woch., xiii, 1863. 

Schmidt, Dr. J. B. Berl. klin. Wochen., vii, 34, 1870. 

Trousseau et Pidoux. Traite de Therap. et de Mat. Med., vol. ii, huitieme edition. 

Waldenburg und Simon. Handbuch der allg. und spec. Arzneiverordnungs-Lehre, 
Berlin, 1873, pp. 397, 666. 

MERCURY AND ITS PREPARATIONS. 

Hydrargyrum. — Mercury. Mercure, Fr. ; Quecksilber, Ger. A sil- 
ver-white metal, liquid at common temperatures, and having the spe- 
cific gravity 13 5. It is wholly volatilized by heat, and is dissolved 
without residue by nitric acid. 

Prepaeations. — JEmplastrum Ammoniaci cum Hydrargyro.— 
Plaster of ammoniac with mercury. Composition : Ammoniac, 720 
parts ; mercury, 180 parts ; olive-oi], 8 parts ; sublimed sulphur, 1 part. 

Mnplastrum Hydrargyri. — Mercurial plaster. Composition : Mer- 



MERCURY. 245 

cury, 30 parts ; olive-oil and resin, of each, 10 parts ; lead-plaster, 50 
parts. 

Hydrargyrum cum Creta. — Mercury with chalk. Composition : 
Mercury, 38 parts ; prepared chalk, 50 parts ; sugar of milk, 12 parts. 
A gray powder partly dissipated by heat. When a small portion is 
treated with dilute acetic acid in excess, it is partly dissolved, nothing 
remaining but mercury in the form of minute globules not visible by 
a magnifying power of ten diameters. Dose, gr. ss — gr. x. Eight 
grains contain three grains of mercury. 

Massa Hydrargyri. — Pills of mercury. Blue mass. Composi- 
tion: Mercury, confection of rose and licorice-root powdered. Each 
three grains contains one grain of metallic mercury. Dose, gr. ss — 
gr. xv. 

Unguentum Hydrargyri. — Mercurial ointment. Composition : 
Mercury, lard, suet, and compound tincture of benzoin. 

Hydrargyri Oxidum Flavum. — Yellow oxide of mercury. An 
orange-yellow powder, which, on being heated, assumes a red color ; 
then, if the heat be increased, it evolves oxygen, and finally the mer- 
cury evaporates without residue. 

Unguentum Hydrargyri Oxidi Flam. — Ointment of yellow oxide 
of mercury. Composition: Yellow oxide, 10 parts ; ointment, 90 parts. 

Oleatum Hydrargyri. — Oleate of mercury. . Yellow oxide, 10 parts ; 
oleic acid, 90 parts. 

Hydrargyri Oxidum Rubrum. — Red oxide of mercury. Red 
precipitate. An orange-red powder, entirely soluble in muriatic acid. 
When heated it does not emit reddish fumes, but gives off oxygen, 
while the mercury either runs into globules or is wholly dissipated. 

Unguentum Hydrargyri Oxidi Rubri.y— Ointment of red oxide of 
mercury. Composition: Red oxide, 10 parts ; ointment, 90 parts. 

Hydrargyri Sulphas Flava. — Yellow sulphate of mercury. Tur- 
peth mineral. A lemon-yellow powder, sparingly soluble in water. 
It is entirely dissipated by heat, sulphurous acid being evolved, and 
globules of mercury sublimed. Dose, grs. ij — grs. v, as an emetic. 

Hydrargyri Chloridum Corrosivum. — Corrosive chloride of mer- 
cury. Corrosive sublimate. In colorless crystals or crystalline masses, 
which are fusible, and sublime without residue. It is entirely soluble 
in water (1 in 16), alcohol (1 in 7), and in 4 parts of ether. Lime- 
water causes a yellowish precipitate and ammonia a white one, from 
its solution. Dose, gr. -£$ — gr. y 1 ^. 

Hydrargyri Chloridum Mite.— Mild chloride of mercury. Calo- 
mel. A white powder, wholly volatilized by heat, and insoluble in 
water, alcohol, and ether. With solution of potassa it yields a black 
precipitate of oxide of mercury, which is reduced by heat to the me- 
tallic state. Distilled water, after having been boiled with it, yields 
no precipitate with ammonia or nitrate of silver. Dose, gr. -^ — grs. x. 



246 AGENTS INCREASING WASTE. 

Pilulm Antimonii Composite. — Compound pills of antimony. 
Plummers' pills. Composition : Sulphurated antimony, calomel, and 
guaiac. Each pill contains one-half grain each of antimony and calo- 
mel, and one grain of guaiac. 

Hydrargyri Cyanidum. — Cyanide of mercury. In white prismat- 
ic crystals, soluble in 12*8 parts of water. When muriatic acid is 
added to the solution, hydrocyanic acid is evolved, made evident by 
its odor, and bichloride of mercury is left, which is entirely volatilized 
by heat. Dose, gr. -^ — gr. f 

Hydrargyrum Ammoniatum. — Ammoniated mercury. White pre- 
cipitate. In white powder or pulverulent masses, decomposed and 
entirely dissipated by a strong heat, insoluble in water and alcohol, 
but dissolved without effervescence by muriatic acid. 

Unguentum Hydrargyri Ammoniati. — Ointment of ammoniated 
mercury. Composition : Ammoniated mercury, 10 parts ; benzoinated 
lard, 90 parts. 

Hydrargyri Iodidum Viride. — Green iodide of mercury. A green- 
ish-yellow powder, which becomes red when heated. It is insoluble 
in water and alcohol. Dose, gr. -J- — gr. j. 

Hydrargyri Iodidum Hubrum. — Red iodide of mercury. A red 
powder, which becomes yellow when heated, and red again when cold. 
It is wholly volatilized by heat, condensing in scales, which are at first 
yellow, but afterward become red. It is insoluble in water, but is dis- 
solved by boiling alcohol, and by solutions of iodide of potassium and 
chloride of sodium. Dose, gr. ^ — gr. T *g-. 

Unguentum Hydrargyri Iodidi Rubri. — Ointment of red iodide 
of mercury. Composition : Red iodide, 10 parts ; ointment, 90 
parts. 

Hydrargyri Sulphuretum Rubrum. — Red sulphuret of mercury. 
Cinnabar. In brilliant crystalline masses, of a deep-red color and 
fibrous texture. It is entirely volatilized by heat. When heated with 
potassa, it yields globules of mercury. It is not soluble in either nitric 
or muriatic acid, but is dissolved by a mixture of the two. Acetic acid 
which has been digested with it does not yield a precipitate with iodide 
of potassium. 

Liquor Hydrargyri JVitratis. — Solution of nitrate of mercury. 
Mercury dissolved in nitric acid. Acid nitrate of mercury. " A trans- 
parent, nearly colorless, acid liquid, having the specific gravity 2*100. 
It is not precipitated by the addition of distilled water ; and the di- 
luted solution affords, with potassa, a dirty-yellow precipitate, and with 
iodide of potassium a bright-red one, soluble in an excess of the pre- 
cipitant. When dropped on a bright surface of copper, the diluted 
solution instantly deposits a coating of mercury." 

Unguentum Hydrargyri JVitratis. — Ointment of nitrate of mercury. 
Citrine ointment. 



MERCURY. 247 

TTnguentum Hydrargyri Nitratis JRubrum. — Brown citrine oint- 
ment. (Unofficial.) This differs from the preceding and official citrine 
ointment, in being made with cod-liver oil. It is dark brown in color, 
more agreeable in odor, and more efficient as a remedy. 

Oleatum Hydrargyri. — Oleate of mercury. " Yellow oxide of mer- 
cury, 10 parts ; oleic acid, 90 parts." 

Antagonists and Incompatibles. — Corrosive sublimate is incom- 
patible with alkalies and their carbonates, lime-water, tartar emetic, 
nitrate of silver, acetate of lead, albumen, iodide of potassium, soaps, 
various vegetable infusions, including cinchona. Calomel is incom- 
patible with the alkalies and alkaline earths and alkaline carbonates? 
with iron, lead, and copper. It should not be given in the same pre- 
scription with iodine (forms red iodide), and nitro-muriatic acid should 
not be prescribed in conjunction with it, lest corrosive sublimate be 
formed. There is little doubt, also, that calomel is converted into 
corrosive sublimate by the chlorides of sodium, potassium, and ammo- 
nium. The acids and acidulous salts are incompatible with hydrargy- 
rum cum creta. 

In cases of poisoning by mercurial salts, especially corrosive subli- 
mate, albumen, white of egg, wheaten flour, milk, etc., may be admin- 
istered. The white of one egg is considered sufficient for four grains 
of corrosive sublimate. An excess of albumen may redissolve the com- 
pound. Emesis should be promptly induced. 

Synergists. — Depressing medicines, antimony, alkalies, especially 
alkaline chlorides, etc., promote the physiological activity of mercurials. 

Physiological Actions. — Metallic mercury in direct contact with 
the skin or mucous membrane is without action. Swallowed, it is pur- 
gative by virtue of its weight. If retained in the intestinal canal, it 
will form soluble combinations, enter the blood, and produce charac- 
teristic systemic effects. Similarly prolonged contact with the skin 
will be followed by the constitutional action of the drug. Injected 
into the veins, it will be arrested in the capillaries, producing the usual 
phenomena of capillary embolism. Mercury gives off vapors at the 
ordinary temperatures, which have, in notable instances, caused serious 
constitutional symptoms. As used in the mechanical arts, by gilders 
and others, the fumes of mercury cause wasting, ptyalism, necrosis of 
bones, trembling, impaired intellect, and in women, abortion. With- 
out producing such obvious effects as ptyalism, mercurial cachexia, 
eczema, and disease of the bones, obscure nervous phenomena may re- 
sult. Among these may be enumerated headache, loss of memory, 
trembling, defects of co-ordination, disorders of sensation, convulsions, 
and dementia. 

Mercury is readily absorbed — as a vapor by the pulmonary mucous 
membrane, when applied to the integument, or when taken into the 
alimentary canal. It probably exists in the blood as an albuminate. 



248 AGENTS INCREASING WASTE. 

Recent experiments (Wilbouchewitch, Keyes) have shown that mer- 
cury, as iron, manganese, and other metals, has the power to increase 
the number of red corpuscles, and to improve the quality of the blood, 
provided it is exhibited in small quantities, not often repeated. It has 
long been known (Liegeois) that this result followed the use of cor- 
rosive chloride in syphilis. Schlesinger has recently gone over the 
question anew with the same result, but he doubts whether the effects 
are really tonic. It remains true, however, that any considerable 
quantity of mercury, administered a sufficient time, will affect the 
quality and composition of the blood ; the red globules are diminished 
in number ; the fibrin loses its plasticity ; the proportion of water is 
increased, and various effete materials, whose nature is unknown, ac- 
cumulate. Mercury is deposited in all the textures, interferes with 
the normal nutritive processes, and is found in all the secretions and 
excretions. A marked degree of anaemia, loss of flesh, muscular weak- 
ness, intractable ulcerations of the skin, loss of hair, eczema, a foul 
breath, diarrhoea, the stools being very fetid, are the characteristic 
symptoms of the action of mercury on the solids and fluids of the body. 

This metal has a selective action on the lymphatic glandular sys- 
tem, and notably on the salivary glands and pancreas. Among the 
earlier symptoms of the action of mercury are an increase of the sali- 
vary secretion, an alteration of its quality, fetor of the breath, swol- 
len tongue, soreness of the teeth, a blue or dark slate-colored line 
along the margin of the teeth, sponginess of the gums, swelling of the 
parotid, sublingual, and submaxillary glands, aching of the jaws and 
teeth, with general muscular soreness and aching of the limbs, and 
some elevation of temperature. To this state are applied the terms 
acute mercurialismus, ptyalism, in common language, salivation. 
Mercury certainly stimulates the pancreas ; this gland, like the sali- 
vary glands, becomes swollen, congested, and pours out an abundant 
secretion which, however, is not a normal but a pathological secretion. 
There is little doubt also that mercury increases the action of the in- 
testinal glandular appendages, and thus acts as a purgative. It not 
only increases the activity of these glands, but is itself in part ex- 
creted by them. The products of the increased waste of the tissues 
caused by mercury are also largely eliminated by the intestinal glands. 
These actions of mercury should not be regarded as a physiological 
stimulation of the intestinal glands, in the sense that the foods are 
stimulant to these organs. The action is pathological, and the prod- 
ucts of the action are pathological. 

Mercury, like the metals in general, is excreted by the liver, and 
manifests a tendency to accumulate in this organ. Like the metals in 
general (iron, manganese, arsenic, copper, etc.), mercury doubtless 
acts as a stimulant to the hepatic cells, and increases their products. 
Just as an altered salivary or pancreatic fluid is produced by the action 



MERCURY. 249 

of mercury, so an altered or pathological bile is the result of the stim- 
ulation of the hepatic cells by this metal. That its use increases 
the physiological and normal products of the liver seems an assump- 
tion hardly warranted by the facts which have now been accumulated. 
That mercury (pil. hydrarg., calomel, hydrarg. cum creta), in purgative 
doses, increases the flow of bile into the intestine — is a cholagogue — 
can not be successfully disputed ; but it is a cholagogue in the sense 
that croton-oil and the resinous purgatives are : by irritation of the 
mucous membrane of the duodenum, it causes a reflex contraction of 
the gall-bladder and hepatic ducts, and an outflow of bile is the result. 
The presence of alimentary matters in the duodenum suffices to in- 
crease the production and discharge of bile ; purgatives, for the time 
being, somewhat more energetically produce the same result. A pur- 
gative dose of blue-pill, or calomel, may therefore cause bilious evacu- 
ations, but other purgatives may accomplish the same. Repeated 
stimulation of the liver by mercurials can only result in the production 
of an altered bile, and may, indeed, cause the organ to strike work, if 
too long persisted in. If we add to the cholagogue properties of mer- 
cury, which it possesses in common with resinous purgatives, the ac- 
tion on the pancreas and the increased elimination of the products 
of waste by the intestinal glands, we obtain a satisfactory explana- 
tion of those powers which have, under the term alterative, been here- 
tofore ascribed to mercury. 

Mercury is eliminated by the salivary and the intestinal glands, by 
the liver, but chiefly by the kidneys. A small portion of the metal 
escapes by the skin also. The excretion of mercury is hastened and 
completed by the iodide of potassium. As a result of the changes in 
the composition of the blood, and of the direct action of the metal on 
the renal epithelium, albuminuria is one of the symptoms present in 
cases of mercurialism. Without the use of special means to render 
it soluble, and despite the use of such means, sometimes mercury 
remains permanently in the organism. When extremely severe cases 
of salivation were not uncommon, permanent damage to the osseous 
structures often occurred, and globules of mercury could be shaken 
out of the dried bones of such subjects. Happily, nowadays, such 
cases do not occur. The moderate use of mercury, short of ptyalism, 
does not appear to affect the human system injuriously. 

Effects of the Different Preparations. — Hydrargyrum cum 
creta, calomel, and blue-pill are very similar in action. Calomel, being 
insoluble, probably escapes solution and combination in the stomach, 
and is decomposed by the alkaline contents of the small intestine, 
the oxide of mercury being precipitated. It follows, from this re- 
action, that the effects of blue-pill and calomel must be similar, and 
in practice it is found that they correspond closely therapeutically. 
Salivation more frequently results from the use of blue-pill than the 



250 AGENTS INCREASING WASTE. 

other mercurials ; and calomel is next in point of activity in this 
respect. 

The corrosive chloride, the red iodide, and the cyanide, are pow- 
erful irritant and corrosive poisons. When a poisonous dose of cor- 
rosive sublimate has been swallowed, the mucous membrane of the 
mouth has usually, but not invariably, a whitish, glazed appearance, 
as if it had been washed over with a strong solution of the nitrate of 
silver. A sense of constriction of the throat and a strong styptic and 
metallic taste are experienced. The toxic symptoms follow in a few 
minutes the ingestion of the poison. Usually, violent pain is felt in 
the abdomen, but this is not invariable. Vomiting follows, and the 
vomited matters consist at first of the contents of the stomach, and 
afterward of mucus streaked with blood. There are usually purg- 
ing, tenesmus, intestinal cramp, and not unfrequently dysenteric dis- 
charges. These evidences of violent gastro-intestinal irritation are ac- 
companied by small, weak pulse, coldness of the surface — but some- 
times by a swollen and flushed face — sighing respiration, syncope, 
insensibility, or convulsions. If the patient survive a few days, pty- 
alism may occur. 

The following are the symptoms of chronic poisoning : abdominal 
pains ; nausea ; vomiting ; dysenteric diarrhoea ; general weakness, 
trembling, or paralysis ; ptyalism ; fever ; emaciation, etc. There 
sometimes occurs a blue line along the margin of the teeth, not unlike 
that produced by lead. 

Suppression of urine is a not infrequent symptom in acute poison- 
ing, and albuminuria is very often present in cases of chronic mer- 
curialismus. 

Therapy. — The acute glandular affections of throat and neck — 
tonsillitis, parotitis, inflammation of the submaxillary and sublingual 
glands — are often speedily removed by mercurial preparations. The 
one twentieth of a grain of calomel, the one fifth of mercury with 
chalk, may be given every two hours, or one minim of the follow- 
ing solution may be administered at the same interval : $ Hydrarg. 
chlor. corrosiv., gr. j ; aquae, 3 j. M. Sig. : Dose, Tq, j. Chronic af- 
fections of these organs are not benefited by these remedies, and the 
so-called scrofulous diseases of the cervical glands are made worse by 
them. 

Corrosive sublimate is an effective remedy in gastric ulcer. The 
thirtieth to the sixtieth of a grain, three times a day before meals, is a 
proper quantity and occasion for this purpose. Certain kinds of vom- 
iting are quickly cured by small doses of calomel. The vomiting of 
children, caused by indigestible food or by constipation, or by these 
causes combined, is often speedily relieved by one-twelfth-of-a-grain 
doses of calomel every half -hour or hour, dropped on the tongue. This 
remedy is the more efficacious when such vomiting is accompanied by 



MERCURY. 251 

great heat of head, restlessness, and fever. The vomiting of cholera 
infantum is often stopped by the same means. 

It has long been held that mercurials are specially indicated in that 
catarrhal state of the intestinal mucous membrane and of the hepatic 
duct, manifested by nausea, anorexia, tympanites, whitish or clay-col- 
ored stools, and jaundice. The use of mercury in these cases is predi r 
cated on its supposed power to promote the flow of bile. It is true, 
no doubt, that calomel and blue-pill will remove these symptoms, but 
such mild salines as phosphate of soda, sulphate of magnesia, tartrate 
of soda and potassa, etc., will usually succeed quite as well and with- 
out detriment to the patient. The diarrhoea and dysentery of infants 
(ileo-colitis) is frequently treated by minute doses of calomel or hy- 
drargyrum cum creta. When there are much straining and bloody 
mucus, it is said that small doses of corrosive chloride prove very 
effective, but the author is convinced that mercurials are much abused 
in these affections. Children are quickly poisoned by mercurials, al- 
though they are not easily salivated. The spinach-colored stools 
which so frequently occur in the summer complaint of children, and 
which are, by ignorant practitioners, supposed to be produced by the 
mercury administered, really belong to cases of ileo-colitis, and may, 
by their persistence and profuseness, signify an increased irritation of 
the intestinal mucous membrane due to the remedies given. While 
the author believes that other medicines are more useful than mercury 
in the ileo-colitis of children, he is convinced of the utility of minute 
doses of calomel (one twentieth to one twelfth of a grain every half- 
hour) when there is much irritability of the stomach. Mercurials are 
contraindicated in the diarrhoea and dysentery of adults, as a rule. 

It was formerly an article of faith to hold that mercury was a sov- 
ereign remedy in hepatic disorders. The state known as biliousness, 
characterized by a yellowish-coated tongue, yellow conjunctivae, muddy 
skin, nausea, constipation, may be removed by a mercurial purge when 
these symptoms are due to catarrh of the duodenum, excesses of the 
table, sudden checking of the perspiration, etc. The blue-pill, or 
mercury with chalk, or calomel, succeeds in these cases by removing 
offending substances from the intestinal canal, by relieving a catarrh- 
al state of the mucous membrane, or by causing elimination of waste 
products by the intestinal glandular apparatus. Less objectionable 
agents may be employed with equal success. 

The experience of the India medical officers has shown conclusively 
that mercurials are harmful in acute hepatitis, hepatic abscess, jaundice 
from gall-stones, acute yelloio atrophy, etc. As these affections are 
very rife in India, an experience which has led to such conclusions 
should be heeded. There is no evidence to show that mercurials ren- 
der the least service in cirrhosis. 

Calomel is a very efficient purgative. It will be retained when 



252 AGENTS INCREASING WASTE. 

other purgatives are rejected by the stomach ; it is free from taste, 
and may therefore be given easily to children. When it operates, 
nausea and tormina may be experienced. One grain of calomel at 
night will act in the morning, and not unfrequently a half-grain will 
give satisfactory results. A full purgative dose of calomel (five grains) 
is an excellent vermifuge for the lumbricoid worms. It may be given 
with santonine. At the onset of acute febrile diseases, calomel is a 
useful purgative ; it hastens waste, and causes the elimination of the 
products by the intestine. 

Mercurials were formerly much esteemed in the treatment of acute 
inflammation, especially of serous membranes. As calomel — the mer- 
curial preparation usually employed — was combined with opium, it was 
not known to which remedy the good results were due, but the mer- 
curial was considered to have the larger share of merit. It is now 
admitted that opium was the effective agent. An apparent exception 
to this statement exists in the case of iritis, a disease in which the 
good effects of mercury are most conspicuous ; but iritis, probably, is 
always of syphilitic origin, and, in syphilitic inflammation of serous 
membranes, it is not disputed that mercurials are extremely efficacious. 
In these days, however, although opium is considered indispensable in 
peritonitis, pleuritis, pericarditis, etc., mercury is no longer combined 
with it. No longer is it considered necessary to " touch the gums " 
in order to cure a serous inflammation, and only the most prejudiced 
and benighted practitioners insist in the use of mercurials in these in- 
flammatory affections. 

Large doses of calomel — five grains every four hours — are said to 
be very efficacious in true croup or membranous laryngitis. It is 
claimed that it allays spasm and checks the formation of the false 
membrane. The author is skeptical in regard to the utility of calomel 
in this affection. There is, however, no doubt as to the value of the 
yellow subsulphate (turpeth mineral) as an emetic in this disease. If 
given early, it is the doubtful statement of Dr. Fordyce Barker, of New 
York, that a fatal result will most certainly be averted. From two 
to four grains of the subsulphate may be given as an emetic for a child 
with croup. Serious results might be produced by this dose if emesis 
did not so promptly follow. The powder comes up with the contents 
of the stomach, in from five to fifteen minutes after being swallowed. 
But little depression follows the emesis produced by turpeth mineral, 
in which respect it has a decided advantage over sulphate of cop- 
per, tartar - emetic, and even ipecacuanha. As it is insoluble, this 
remedy should be rubbed up with sugar and placed on the base of 
the tongue. 

Corrosive sublimate has lately been used with very distinct advan- 
tage in the treatment of diphtheria. Its remarkable germicide prop- 
erty is the motive for its employment, and clinical experience strongly 



MERCURY. 253 

supports the results of experiment. The dose administered in the 
treatment of diphtheria will range, according to the age of the sub- 
ject, from y^o grain to -^ grain every four or six hours. 

Liebermeister, following the lead of Traube, Wunderlich, and others, 
has obtained surprising results from the use of calomel in typhoid fever. 
By our German confreres this treatment is called the specific treatment 
of abdominal typhus. It consists in the administration of ten grains 
of calomel in a single dose the first day, and eight grains a day for 
three or four days thereafter. It is a curious fact that these large 
doses of calomel have an antipyretic effect. According to the statis- 
tics of Liebermeister, the " specific " calomel treatment shortens the 
duration and lessens the mortality from typhoid fever, as compared 
with the non-specific, expectant, or other plans of medication. 

Calomel is one of the numerous remedies used in the treatment of 
cholera Asiatica. Two methods are pursued : large doses at consider- 
able intervals ; small doses frequently repeated. The latter method is 
nowadays much more usually practiced. In consists in giving every 
fifteen minutes, half -hour, or hour, the one sixth, one half, or one grain 
of calomel, combined with opium, chalk, piperine, etc. The author, 
who has had considerable experience in the treatment of cholera, can 
not express any degree of confidence in the efficacy of this treatment. 
Large doses (a scruple to a drachm) sometimes appear to arrest vomit- 
ing when other means fail, but there is danger of excessive ptyalism 
when reaction sets in. 

The most important application of mercury therapeutically is in 
the treatment of syphilis. It may be regarded as a specific in this dis- 
ease. The reaction which set in against its use a few years ago has 
certainly led to important modifications in the mode and quantity in 
which mercury should be given ; but the fact has been conclusively 
established that mercury in a certain sense is antidotal to syphilis. 
As mercury arrests the proliferation of the syphilitic virus in the blood, 
this agent should be used with the earliest manifestations of the specific 
character of the infecting sore. Mercury is not indicated in chancroid, 
or non-infecting chancre, and should not be used. If the chancre have 
the characteristic quality of the infecting sore, small doses of one of 
the mercurial preparations should be begun and continued steadily 
until all induration has disappeared. The important point is, not to 
induce ptyalism. It is now conceded that the danger of a relapse will 
be very much lessened by continuing the mercurial treatment for some 
time — for several months — after local manifestations have ceased. 
The ill effects of a mercurial course may be prevented by the use of 
small doses, by careful attention to hygiene, and by lessening the dose, 
or discontinuing the remedy entirely, whenever soreness of the jaws 
can be developed by smartly closing the teeth. By the adoption of 
these precautions, a mercurial course may be continued without im- 



254 AGENTS INCREASING WASTE. 

portant interruptions until the period of incubation has entirely passed, 
and through the so-called secondary or constitutional stage. 

Various methods are resorted to for the introduction of mercury 
into the organism : 

1. Inunction. — Before practicing inunction, the patient should take 
a warm bath, or, at least, wash the part to be operated on with soap 
and water. From fifteen to thirty grains of mercurial ointment is the 
quantity required for each inunction. The oleate of mercury in pro- 
portion of fifteen to thirty per cent in the solution may be substituted 
for the ointment, but the oleate is to be applied with a brush, and not 
be rubbed in. Sigmund, the great advocate for the inunction method, 
has prescribed certain rules, which should be followed. The ointment 
should be rubbed in with moderate friction by the palm of the hand : 
on the first day on the legs ; on the second day on the thighs ; on the 
third day on the abdomen and sides of the chest ; on the fourth day 
on the back ; on the fifth day on the arms. Mercurial inunctions are 
not borne equally well by all patients. Some are easily salivated, and 
others suffer from eczema or erythema. Moreover, the inunction treat- 
ment is filthy and troublesome, and it should, therefore, be restricted 
to those cases in which mercurials are badly borne by the stomach. 

2. Fumigation. — Various mercurial preparations may be used — the 
sulphuret, the iodide — but calomel is the best. The apparatus consists 
of a spirit-lamp, a plate to hold the calomel, surrounded by a shallow 
vessel containing water, a blanket large enough to cover the patient 
and the apparatus. The calomel is volatilized by the heat of the lamp, 
and is deposited, together with the vapor of water, on the skin of 
the patient. About fifteen minutes is the time required for the bath, 
and the quantity of calomel used ranges from eight to fifteen grains. 
The method of fumigation is especially adapted to cases of the con- 
stitutional, or secondary, and to the tertiary, with ulcerations, when 
the state of the patient is such as to forbid the internal administration 
of mercurials. 

3. Hypodermatic Method. — This consists in the introduction under 
the skin of corrosive chloride, or albuminate of mercury. 3 Hydrarg. 
chlor. cor., gr. j ; glycerini, 3 j ; aquse destil., 3 ]*• M. Sig. : Ten min- 
ims a dose once a day. This method is cleanly, quick in results, and 
more successful than any other in preventing relapses. 

The peptonate of mercury, as advocated by Bamberger, has been 
much employed lately for the treatment of syphilis by the subcutane- 
ous method ; but the albuminate alone, without pepsin, is both more 
effective and less likely to set up local inflammation. The following 
formula for the preparation of albuminate of mercury, recommended 
by Gourgues, is probably the best now available for this purpose : 
Bichloride of mercury, gr. xv ; distilled water, 3 v. To this solution 
is added five drachms of white of egg, and, after thorough shaking, 



MERCURY. 255 

the mixture is incorporated with the following : Chloride of sodium 
(common salt), gr. xxx ; distilled water, f 3 ij. This mixture is then 
well agitated, and afterward filtered, after which sufficient distilled 
water is added to make the solution up to four fluid ounces. The dose 
of this solution for hypodermatic injection is from ttt, xv — 3 ss. When 
finished, the solution is not clear, but rather semi-transparent ; but it 
remains longer and better in solution than most of these preparations. 
The peptonate of mercury is not only variable in composition, but 
easily undergoes change, and is liable to produce violent local irrita- 
tion. The albuminate prepared as above suggested is readily admin- 
istered, is not painful, and is rarely followed by unpleasant accidents 
at the site of the injection. As regards the results of the administra- 
tion on the progress of the disease, they are remarkable (Gourgues). 
According to Martineau, the hypodermatic mercurial treatment exer- 
cises on syphilis in its various manifestations an action much more 
effective, more energetic, and more rapid, than any other method hith- 
erto proposed. The subcutaneous areolar tissue of the back is the best 
place for the injections. The number of them and the quantity of 
fluid used will depend on the stage of the disease, the severity of the 
manifestations, and the condition of the patient. 

Besides the preparations above mentioned, other solutions of corro- 
sive chloride have been proposed. Matthes recommends the follow- 
ing : Bichloride of mercury, gr. xv ; chloride of sodium, gr. xxx ; dis- 
tilled water, f f iij. Make a solution. Matthes had observed the 
action of this during two years at Auspitz's polyclinic. The usual dose 
was a Pravaz syringeful — fifteen to twenty minims — every two days. 
No irritation is produced beyond some tumefaction, and, in general, 
twenty to thirty injections sufficed to effect a cure. 

Recently, Liebreich has brought forward the formamide of mer- 
cury as the most suitable preparation for the hypodermatic method. 
It is neutral in reaction, readily soluble in water, and does not coagu- 
late albumen. 

4. Internal. — This method, in the nature of things, must be most 
frequently resorted to. Various mercurial preparations are used by 
different syphilographers. The Ricord school prefer the green iodide ; 
Sigmund, mercurial-ointment inunctions ; Foerster, the yellow iodide ; 
Berkeley Hill, the red iodide ; Tilbury Fox, the cyanide ; Bumstead 
advises mercurial pill, the green iodide, the bichloride, according to 
circumstances, but his preference is for the use of calomel by fumi- 
gation. That preparation of mercury is to be preferred which best 
agrees with the patient, is the rule. 

The indications for the use of iodine preparations have already been 
stated, but it may be useful, now, to place in juxtaposition the com- 
parative utility of mercury and iodine : mercury for the primary in- 
fecting sore ; mercury for the affections of the skin, especially macular 



256 AGENTS INCREASING WASTE. 

and papular exanthemata ; iodine for the tertiary symptoms : gummata ; 
tubercular syphilides ; serpiginous ulcers ; affections of the bones and 
periosteum, and nervous diseases. 

Hydrargyrum cum creta is usually preferred for the treatment of 
congenital syphilis. Mr. Marshall recommends the twenty-per-cent 
ointment (the size of a pea) of the oleate of mercury, to be placed in 
the axilla night and morning for five or six days. 

Local Uses of Mercurials. — Recent experimental investigations on 
the action and comparative germicide properties of the various anti- 
septics have shown the superiority of corrosive sublimate over all 
others ; hence it has come to be largely used in the dressing of wounds, 
and as a local application to specific ulcerations, etc. The acid nitrate 
of mercury is one of the best caustics for the destruction of chancroid. 
It should be applied with a glass rod after the surface of the sore 
has been well cleansed. It is now conceded that destruction of an 
infecting chancre does not prevent systemic infection. Syphilitic 
warts and vegetations on the genitals are amenable to the same treat- 
ment. Erosions and ulcerated indurations are best treated by 
" black - wash " (calomel, eight grains — lime-water, one ounce), or 
" yellow-wash " (one grain of corrosive sublimate to an ounce or two 
of lime-water). The surface of the sore may be kept wet with these 
lotions. 

Ricord's treatment of condylomata consists in washing them with 
a solution of chlorinated soda, and then dusting them with calomel. 
Mercurial applications are of very great service in cutaneous affections 
of syphilitic origin. A drachm of calomel to an ounce of lard makes 
an ointment which is very serviceable in herpes, psoriasis, and pruritus 
of the vulva and anus. Ringer speaks of calomel-ointment in terms 
of great praise in various itching affections, especially of the anus and 
perinseum. In acne, lotions containing corrosive sublimate, and oint- 
ments of green and red iodide, are much employed : $ Hydrarg. 
chlor. cor., 3] ; glycerini, 1 ss ; spts. vini rect., f vij ; spts. rosmar., 
3 iv. M. For acne and pityriasis of the scalp : fy Hydrarg. iod. 
virid., gr. x ; adipis, § j. M. $ Hydrarg. iod. rubri, gr. v ; adipis, 
§ j. M. For acne indurata. The following is Startin's lotion of 
corrosive sublimate for syphilitic eruptions : J£ Hydrarg. chlor. cor., 
gr. iv ; acid, nitric, dil., 3 j ; acid, hydrocyan. dil., 3 j ; glycerini, 3 ij ; 
aquae, § viij. M. F 'or pityriasis, chloasma, etc. 

Lotions of corrosive sublimate are much employed in the treatment 
of parasitic skin-affections. The stronger ones must be used with cau- 
tion. It is rarely necessary to use a lotion stronger than two grains to 
the ounce. The following is an excellent formula of Tilbury Fox : I£ 
Hydrarg. chlor. cor., grs. iv ; alcohol, 3 vj ; ammonias muriat., 3 ss ; 
aquae rosae, q. s. ad | vj. M. For scabies, ptheiriasis, and tinea versi- 
color. A scruple of corrosive sublimate to the ounce of simple oint- 



MERCURY. 257 

ment is an effective application in favus and tinea tonsurans, when 
used in the early stages of these affections. 

Calomel finely levigated and dusted over the membrane by means 
of a camel's-hair brush is an excellent local application in phlyctenidar 
ophthalmia. Eczema of the margin of the eyelids is quickly cured by 
rubbing in every night, after detaching the scales, a small quantity of 
the brown citrine-ointment. Chronic inflammation of the external 
auditory meatus is cured by the same application, viz ., by allowing a 
small quantity of the brown citrine-ointment to remain in contact with 
the integument. 

Mr. Marshall strongly recommends the oleates in parasitic skin-dis- 
eases. He employs a five-per-cent solution of oleate of mercury in 
oleic acid, adding an eighth part of ether. This is applied by means 
of a camel's-hair brush. It is used in sycosis, tinea, and chloasma, 
porrigo, pruritus ani, and pruritus pudendi. The oleates are extremely 
serviceable remedies for the local treatment of syphilitic induration, 
but they are not advisable when ulceration exists. 

The oleate of mercury and morphia (obtained by the addition of 
the alkaloid morphia) is an elegant and efficient application in super- 
ficial inflammations, especially of joints of the rheumatic and arthritic 
varieties. Inflammatory indurations, left after the subsidence of acute 
trouble, are removed by the same combination. For application to 
these purposes Mr. Marshall employs a five-per-cent, ten-per-cent, and 
twenty-per-cent solution of oleate of mercury in oleic acid. To every 
drachm of such solution he adds one grain of morphia. 

Mr. C. Bader, the eminent ophthalmologist of London, advises the 
following ointment in conjunctivitis: P> Hydrargyri oxidi rubri, 
gr. x ; atropiae sulph., gr. j ; vaselin., 3]*. M. Dr. Seely, of Cincin- 
nati, strongly urges the use of an ointment of the yellow oxide, eight 
or ten grains to the ounce of vaseline. He directs that the yellow 
oxide be triturated to the utmost degree of fineness, and then thor- 
oughly incorporated with the vaseline, the result being a bright-yellow 
ointment. A portion of this is taken on a probe, the lid lifted up, and 
the whole is wiped off on the mucous membrane. 

For pruritus of the vidva, the following lotion is recommended : 
Hydrarg. chlor. cor., one part ; alum, 20 parts ; starch, 100 parts ; and 
water, 2,500 parts. The official ointment of the red iodide of mercury 
is an effective application in simple hypertrophy of the thyroid gland, 
and an enlarged spleen, or ague-cake. A bit of ointment, the size of 
a large pea, is thoroughly rubbed in over the affected organ, the sun's 
rays falling on the part if practicable, or the friction may be carried 
on before a bright fire, or without. As soon as the skin becomes sore 
the applications are suspended until it recovers, when they may be re- 
sumed. The applications should be made daily. 

For that parasitic affection of the skin, pityriasis, there is no lotion 
17 



258 AGENTS INCREASING WASTE. 

so effective as a strong solution of corrosive sublimate— 3 j — 3 j — 
§ iv of rose-water. It need hardly be observed that these strong 
solutions require very careful handling. Less than necessary will 
fail, and application to an abraded surface will induce toxic symp- 
toms. 

Aurum. — Gold. Or, Fr. ; Gold, Ger. 

Auri Chloridum. — Chloride of gold. (Not official.) Needle- 
shaped prisms of a beautiful yellow color, deliquescent, freely soluble 
in water. Dose, gr. ■&— gr. T \. 

Auri et Sodii Chloridum. — Chloride of gold and sodium. An or- 
ange-colored salt, crystallizing in four-sided prisms, soluble in water. 
Dose, gr. -g^— gr. tV 

Antagonists and Incompatibles. — Eggs, albumen, milk, flour, are 
chemical antidotes. The contents of the stomach should, of course, 
be evacuated. The principles of treatment are the same as for poison- 
ing by corrosive sublimate. 

Synergists. — The salts of mercury, especially the corrosive chloride, 
are very similar in action to the chlorides of gold, and are therefore 
synergistic. 

Physiological Action. — The chloride of gold is a caustic in its 
local action. In toxic dose it excites violent gastro-enteritis, accom- 
panied by such nervous phenomena as cramps, convulsive trembling, 
insomnia, priapism, insensibility, etc. In small medicinal doses these 
auric preparations promote the appetite and the digestive capacity. If 
long continued, especially if the dose be a full medicinal one, epigastric 
pain and distress are excited, nausea is induced, and loss of appetite 
follows. Constipation is usually produced by the preparations of gold, 
and this, notwithstanding an increased secretion of the intestinal 
glandular apparatus is one of the results of their administration. 
These preparations do not probably entirely enter the blood from the 
stomach, but part passes to the intestinal canal, is there decomposed, 
and is absorbed as oxide in combination with albumen. This is, how- 
ever, conjectural. They are readily soluble and are very diffusible 
substances. What particular influence they exert on the composition 
and function of the blood is at present quite unknown. A form of 
fever, known as . auric fever, is caused by their prolonged adminis- 
tration. This fever is accompanied by profuse sweats, a very abundant 
flow of urine, and increased salivary secretion. The salivation caused 
by the preparations of gold differs from the mercurial in that there is 
no tenderness nor ulceration of the gums. 

Peculiar effects on the mental state are produced by the adminis- 
tration of the auric preparations. The functions of the mind become 
more active, and even excited, and a state of cheerfulness is induced. 
In men, marked aphrodisiac effects are produced, and the erections are 



GOLD. 259 

often painful ; in women, increased venereal desires and augmentation 
of the menstrual flow are observed. 

The elimination of the auric preparations takes place by the liver, 
the intestinal canal, but chiefly by the kidneys. The urine assumes a 
bright-yellow color. 

Prolonged administration of medicinal doses induces epigastric heat 
and oppression, headache, dryness of the throat and mouth, gastro- 
intestinal irritation, fever. 

Therapy. — The chloride of gold and sodium in small doses (fa 
grain), three times a day, will relieve nervous dyspepsia. A red and 
glazed tongue, epigastric pain, increased by talcing food, and a tend- 
ency to relaxation of the bowels after eating, are indications for the 
use of this salt. Catarrh of the duodenum, catarrh of the bile-ducts, 
and jaundice dependent thereon, are symptoms which may usually be 
removed by the salts of gold. 

These preparations are employed chiefly in the treatment of syphilis, 
secondary and tertiary. They are indicated in the same cases in which 
corrosive sublimate is found effective. According to the author's ex- 
perience, they are especially adapted to old cases in which a protracted 
mercurial course and the large use of the iodide of potassium have 
failed to remove long-standing tertiary symptoms. He has found them 
very serviceable in recurring syphilitic tdcerations of the throat, syphi- 
litic ozwna, syphiloma of bones, syphilitic phthisis, etc. 

Amenorrhcea, dependent on torpor of the ovaries, may be removed 
by the persistent use of auric preparations. Chronic metritis, with 
scanty menstruation, is often remarkably benefited by them. Sterility, 
dependent on these states, or due to coldness, is more certainly cured 
by these agents than by any other merely medicinal means. It is said 
by Martini that the tendency to habitual abortion may be averted by 
the use of chloride of gold. This authority has also found that dropsy 
of the ovary may be sometimes cured by the same agent. 

Decline of the sexual power in man may be prevented by the use 
of gold salts, and the following are symptoms which may be removed 
sometimes by them : diurnal seminal losses, loeak and inefficient erec- 
tions, inability for the sexual congress, due to irritability of the sexual 
organs. They increase the frequency of the nocturnal losses in those 
who are suffering from plethora of these organs. Cases that are bene- 
fited by the bromide of potassium are increased by the chloride of 
gold, and vice versa. 

The author calls especial attention to the use of the salts of gold in 
chronic BrigMs disease, granular and fibroid kidney, and the so-called 
depurative disease. He has observed remarkable improvement to fol- 
low the persistent use of the chlorides of gold in these affections. They 
are best given in pill-form, and in small doses, fa — fa of a grain three 
times a day. It need hardly be mentioned that these preparations are 



260 AGENTS INCREASING WASTE. 

not adapted to the acute forms of Bright's disease. Further experi- 
ence confirms me in the view above expressed in regard to the value 
of chloride of gold and sodium in the treatment of chronic albuminu- 
ria. Not only, in my own hands, but in cases thus treated by others, 
this remedy has proved to be a very valuable addition to our resources 
in this hitherto intractable malady. 

Excellent results are obtained from the use of these auric prepara- 
tions in certain forms of mental disorder : e. g., melancholia, hypo- 
chondria, and allied mental states, accompanied by depression. Ver- 
tigo and vertiginous sensations, when due to stomach-disorders, are 
often removed by minute doses of the chlorides of gold, but plethora 
and increased intracranial blood-pressure contraindicate their use ; on 
the other hand, they have a high degree of utility when there is pres- 
ent the condition of cerebral anaemia. The author has been favored 
with a private communication from Dr. Bauduy of St. Louis, in 
which this experienced and able physician expresses his confidence 
in the value of this remedy in the treatment of hypochondriasis and 
melancholia, based on much personal experience. The modern expe- 
rience is therefore in harmony with the observations of the refined and 
learned author of the "Anatomy of Melancholy." 

Authorities referred to : 

Gubler, Dr. Adolph. Commentaires du Codex Medicamentarius, Paris, 186S, p. 506. 

Nothnagel, Dr. Hermann. Handbuch der ArzneimiUcllehre, Berlin, 1870, p. 310. 

Martini, Dr. Ludwig. Schmidt's Jahrbucher der gesammlen Medicin, etc., vol. cxlri, 
p. 263. 

Trousseau et Pidoux. Traite de Therapeutique et de Matiere 3fedicale, huitieme edi- 
tion, vol. i, p. 388. 

Argentum. — Silver. Argent, Fr. ; Silber, Ger. 

Argenti Oxiclum. — Oxide of silver. An olive-brown powder, very 
slightly soluble in water. Dose, gr. ss — grs. ij, in pill. 

Argenti JVitras. — Nitrate of silver. A heavy, colorless, anhydrous 
salt, wholly soluble in distilled water, and crystallizing in shining, 
rhombic plates. Dose, gr. £ — gr. ss, in pill, or in solution. 

Argenti JVitras Fusus. — Fused nitrate of silver. In cylindrical 
pieces. Is only used for topical applications. 

Argenti JVitras JDilutus— Diluted (mitigated) nitrate of silver. 
Nitrate of silver, 50 parts ; nitrate of potassa, 50 parts. Formed in 
pencils or cones. 

Argenti Cganidum. — Cyanide of silver. Is a white powder, insol- 
uble in water. Dose, gr. -fa — gr. fa, in pill-form. 

Argenti lodidum. — Iodide of silver. An amorphous powder, yel- 
lowish in color, without taste, and insoluble in water or acohol. Dose, 

Antagonists and Incompatibles. — The soluble chlorides and all 



SILVER. 261 

substances containing them are incompatible with the nitrate of silver ; 
hence most of the natural waters decompose it, because they contain 
more or less common salt. An insoluble chloride of silver is the result 
of the decomposition. The following mineral acids and their salts 
are chemically incompatible : Sulphuric, muriatic, tartaric, and sul- 
phurous. Alkalies and their carbonates, astringent infusions, and 
lime-water are incompatible. In cases of poisoning by nitrate of 
silver, common salt is the appropriate antidote. This should be 
given in solution very freely, to act as an emetic as well as chemical 
antidote. 

Therapeutically the salts of silver are antagonized by all those 
agents which promote constructive metamorphosis. 

Synergists. — All agents promoting waste, as mercury, iodides, etc., 
favor the action, therapeutically, of nitrate of silver. 

Physiological Actions. — Nitrate of silver acts chemically on the 
tissue to which it is applied. It combines with the albumen, and ex- 
cites a superficial inflammation, producing in some subjects vesication, 
in all a whitish eschar. It is, therefore, an escharotic, but of very 
limited activity. The white eschar produced by it, subsequently — 
under the influence of light — becomes brownish-black. 

Nitrate of silver has a strong metallic, styptic taste. A strong solu- 
tion, brushed over the mucous membrane, whitens it. In the stomach, 
the salts of silver produce a sense of warmth at the epigastrium, and, 
in large (toxic) doses, excite a violent gastro-enteritis. Meeting in the 
stomach soluble chlorides, undoubtedly the insoluble chloride of silver 
is formed, but a portion of the salt, probably, at once enters into com- 
bination with albumen and peptones. That the action of nitrate of 
silver, when swallowed, is not that of the chloride, has been experi- 
mentally shown ; hence the conversion of the nitrate salt into chloride 
does not suflice to explain the effects which ensue. Increased secre- 
tion from the intestinal glandular apparatus is produced by the silver 
salts, and the alvine dejections are softer and more frequent. Long- 
continued use of these agents will cause gastro-intestinal catarrh. 

The salts of silver most probably enter the blood as albuminates 
and peptonates. They effect very important changes in the blood, 
which becomes darker and more fluid, the red corpuscles paler and 
altered in outline, the haemoglobin converted into hsematin. A slight 
lowering of the temperature is a result of these changes in the com- 
position of the blood. Various tissues of the body undergo patho- 
logical alterations. The epithelium of the intestinal mucous membrane, 
of the kidneys and liver, becomes swollen and cloudy, and sometimes 
fatty. The amount of bile is increased, and albumen frequently ap- 
pears in the urine. The nutrition of the body is impaired and a pro- 
gressive diminution in weight and strength takes place. The venous 
system is found in a state of stasis ; transudations take place, the 



262 AGENTS INCREASING WASTE. 

action of the heart is rapid and irregular, and the respiration is embar- 
rassed. 

The nervous system participates in the general impairment of 
structure ; tetanic convulsions, paralysis, and insensibility, ensue. The 
paralysis is not due to alterations in the muscular system — for the 
muscles preserve their irritability — but is centric in origin. It is true 
the muscles, in poisoning by silver, become granular and their striae 
obliterated, but their contractility is not destroyed. 

Only a minute part of the silver administered is eliminated by the 
kidneys ; most of it escapes by the liver and the intestinal glands ; but 
a portion remains permanently deposited in the tissues if its adminis- 
tration has been protracted. Rarely is it safe to continue the use of 
the preparations of silver longer than six weeks, and occasional purga- 
tives should be given to promote elimination. An olive, slate-colored, 
or grayish-brown discoloration of the various tissues of the body results 
from a deposition of silver. This is usually first seen at the margin 
of the teeth or on the inside of the lips and cheeks, and is an indica- 
tion that the system is becoming saturated. I find in Sieveking, " On 
Epilepsy," the following instructive instance of argyria : " The pa- 
tient, a man aged sixty, became epileptic in March, 1856, and was 
treated with nitrate of silver almost from the commencement ; for 
nine months he took a daily pill containing six grains, so that, during 
that time, he swallowed nearly three and a half ounces. Toward the 
end of July the skin began to be discolored, but, in spite of gastric 
symptoms, the remedy was persevered in. In 1857 hsematemesis and 
other symptoms of gastric ulceration supervened, while the severity 
of the epilepsy had abated, and, having in the mean time come to 
England, he was admitted to the German Hospital, where he soon 
died. The special interest attaching to the autopsy is connected with 
the extent to which the silver had been deposited in the tissues. The 
parts in the face which had exhibited the greatest intensity of dis- 
coloration, owing to their containing more blood, now presented a tint 
uniform with the rest. In the brain the choroid plexuses presented 
a uniform grayish-blue tint. The lungs were tuberculous and pneu- 
monic, the heart hypertrophic. The stomach contained a large quan- 
tity of acid, brown liquid streaked with blood, and at the upper part 
of the posterior wall was a large ulcer, at the base of which was an 
orifice blocked up by the adherent pancreas. The mucous membrane 
of the duodenum and jejunum was dotted over with many small black 
granules, most closely aggregated along the folds. In the ileum these 
spots became more and more scanty. . . . The spleen was small, its 
veins had an ashen hue, which was due to a finely-granular precipitate 
upon their coats. The liver was small, congested, and fatty ; the small 
branches of the vena portse and of the hepatic veins presented the 
same precipitate of silver throughout, but the capillaries were free from 



SILVER. 263 

it. Fine sections of the hepatic tissue showed numerous black dots, 
each of which occupied the center of an acinus, corresponding to the 
point of exit of a central vein, and the color was produced by a black 
margin surrounding the caliber of the artery. The largest argentine 
deposit was in the kidneys. . . . The pyramids all exhibited a dark- 
gray color, which was deepest, and all but black, near the papillae. 
The tubules in these parts were entirely invested with a dense precipi- 
tate. . . . Parts of the skin taken from the temporal, axillary, and 
digital regions, were examined. Transverse sections showed a pale, 
purplish streak immediately underneath the rete Malpighii, following 
the undulations of the cutis. . . . The glandular epithelium uniformly 
presented fatty degeneration." 

A persistent and long-continued use of the iodide of potassium and 
of the hyposulphite of soda has, in a few fortunate instances, caused 
the absorption and excretion of the silver deposits. The action of these 
systemic remedies for the discoloration may be aided by baths of the 
hyposulphites and by the cautious use of lotions containing the cyanide 
of potassium, which possess a decided solvent power over the silver 
deposits. 

Theeapt. — The oxide and the nitrate of silver are extremely ser- 
viceable remedies in the so-called nervous dyspepsia, and in chronic 
gastric catarrh. They are indicated in the following state of things : 
Pain after taking food, lasting for an hour or more (gastralgia), the 
digestion, although slow, being good ; burning pain, with pyrosis, com- 
ing on after the completion of the stage of stomach digestion ; eructa- 
tions of food, with sour and acrid matters — the first being a gastralgia, 
and the other states being caused by gastric catarrh, and consequent 
fermentation of the starch, sugar, and fats. $ Argenti oxidi, grs. v ; 
ext. hyoscyami, grs. v. M. Ft. pil. no. x. Sig. : One three times a day 
before meals. In chronic gastric catarrh, Frerichs recommends the 
following formula : $ Argenti nitrat., grs. xv ; aq. destil., q. s. ; ext. 
belladonnse, grs. x ; ol. caryophylli, gtt. x ; rad. gentian pulv., ext. 
gentianae, aa q. s. ut ft. pil. no. lx. Sig. : One pill three times a day. 
When there is much pain present, Wilson Fox highly commends the 
combination of nitrate of silver and opium in chronic gastric catarrh, 
but, as constipation so frequently attends this state, belladonna or 
hyoscyamus is usually to be preferred. Notwithstanding the strong 
opinion which Brinton has given adversely to the use of the salts of 
silver in nicer of the stomach, the author agrees with Fox that these 
agents are, in this affection, next in value to bismuth. The oxide, or 
the nitrate, may be given in pill-form, as above, or the nitrate in solu- 
tion. In these stomach-affections, as a rule, the oxide of silver — being 
free from the causticity of the nitrate — is preferable. 

In jaundice dependent on catarrh of the biliary ducts, especially 
when there are present considerable pain and stomach-disorder, the 



264 AGENTS INCREASING WASTE. 

salts of silver not only give relief to some of the more distressing 
symptoms, but assist materially in restoring the functional activity of 
the liver. As respects these hepatic disorders, silver has an action simi- 
lar to arsenic, manganese, mercury, and some other mineral remedies. 

Frequently nitrate of silver is remarkably beneficial in cholera in- 
fantum, after the acuter symptoms have subsided. The following is 
an excellent formula for a child a year old : t> Argenti nitrat., gr. j ; 
acid, nitric, dil., ttl viij ; tinct. opii deod., Til viij ; mucil. acacise, § ss ; 
syrup, simplicis, 3 ss ; aquae cinnamomi, ^ j. M. Sig. : A teaspoonful 
every three, four, or six hours. The nitrate of silver is also an efficient 
remedy in that form of diarrhoea in children in which the stools are 
white, pasty, and offensive, and the urine is high-colored and acrid. In 
dysentery, both of children and adults, after the acute symptoms have 
ceased, and in chronic dysentery, the nitrate of silver is a most efficient 
remedy. In some epidemics of acute dysentery, when the constitutional 
condition is one of depression, it is equally effective. In these mala- 
dies it is better to prescribe the nitrate in pill-form (gr. \ — gr. j) com- 
bined with opium. With the stomach administration of the nitrate 
may be conjoined its local application to the rectal mucous membrane, 
and even in favorable instances to the descending colon. In using 
nitrate of silver by enema, the application, to be effective, should be 
made through a flexible tube passed cautiously to the sigmoid flexure 
or beyond. The bowel, previous to the introduction of the silver solu- 
tion, should be as thoroughly washed out as possible by tepid water. 
From ten to twenty grains of the nitrate of silver, to a pint of water, 
is a suitable proportion for an enema. 

Obstinate dysenteric discharges, either alone or mixed with healthy- 
formed faeces, are not unfrequently caused by an ulcer of the rectum. 
The most effective treatment for such an ulcer consists in the applica- 
tion to it, through a suitable speculum, of the solid stick of nitrate of 
silver. 

The author's experience justifies him in asserting that the most 
effective remedy for the diarrhoea of phthisis is nitrate of silver com- 
bined with opium. When the diarrhoea of typhoid fever resists bis- 
muth, Hope's mixture, and laudanum enemata, a satisfactory result 
may often be obtained by nitrate of silver, as follows : 3 Argenti 
nitrat., grs. iij; pulv. opii, pulv. ipecac, aa grs. vj. M. Ft. pil. no. xij. 
Sig. : One every four or six hours. The nitrate of silver is one of the 
numerous remedies which have been used in the treatment of cholera. 

Formerly nitrate of silver was much employed in the treatment of 
epilepsy, but it has justly fallen into disuse, for, besides the danger of 
tinting the skin, it is not as effective as much less objectionable reme- 
dies. Iodide of silver has proved very useful in the treatment of 
whooping-cough, in the hands of Dr. Bell, of Glasgow. He gives one 
eighth of a grain. Since proposed by Wunderlich, this agent has been 



SILVER. 265 

fairly tested in the treatment of posterior spinal sclerosis (progressive 
locomotor ataxia), and seems to have some influence in retarding the 
progress of the disease. 

Local Uses. — Nitrate of silver is largely used as an external appli- 
cation. A case has recently been reported in which argyriasis was 
produced by the free application of this salt to the fauces, hence some 
care should be exercised in applying it to the mucous membranes. For 
external use, the cylinder and solutions of various strengths are em- 
ployed. The " mitigated " stick is used chiefly by ophthalmologists. 
The most satisfactory solution for local application to the skin is ob- 
tained by dissolving the salt in nitrous ether (gr. v — 3 j — § j of ether). 
This solution acts more energetically than the aqueous solution, and 
will readily vesicate. 

Solutions of nitrate of silver are much less frequently applied than 
formerly to inflamed tonsils, diphtheritic affections of fauces, acute 
laryngeal troubles, oedema of the glottis, etc. In the incipiency of 
tonsillitis, a strong solution (3j — 3 j — | j) may sometimes avert the 
attack, but if the inflammation be well established the irritant action 
of the caustic increases the morbid process. The most enlightened 
modern authorities (Oertel) condemn the use of caustics in diphtheria ; 
forcible detachment of the exudation only increases the chances of 
systemic infection, and injury done to the surrounding healthy mu- 
cous membrane invites the extension of the false membrane. A suffi- 
cient quantity of silver solution, to be effective, can not be applied to 
the larynx, nor even to the aryteno-epiglottidean folds, without the 
aid of the mirror, and this manipulation is hardly available when a 
state of acute inflammation exists. Follicular pharyngitis is one of 
the affections which can be successfully treated by systematic local 
applications of silver solution. Catarrh and idceration of the poste- 
rior nares may be cured by persistent use of the same remedy, the 
application being made by a suitable sponge probang, or brush, passed 
behind the veil of the palate. The appropriate strength for these pur- 
poses will depend, in part, on habit (grs. v — 3j — J j). Very weak 
solution of nitrate of silver (gr. j — \ j) is sometimes used by the 
spray-douche (glass tube) in chronic inflammation of the pharynx, 
larynx, and trachea. Besides the ineffectiveness of this method, it is 
objectionable because the silver spray stains the face and clothing of 
the patient, unless a shield is very carefully used. To ulcers of the 
tonsils, tongue, syphilitic and otherwise, the solid nitrate is often used. 
It is a very painful application, and possesses but slight, if any, advan- 
tages over carbolic acid, which is anesthetic after the first contact. 

A strong solution of nitrate of silver, especially in nitrous ether, is 
a most efficient application to check inflammation in superficial parts, 
e. g., boils, felon (paronychia), thecal abscess, orchitis, synovitis, etc. 
It is essential to the success of this treatment that the application be 



266 AGENTS INCREASING WASTE. 

made early. According to the method of Mr. Furneaux Jordan, it is 
better to make these applications to the adjacent "vascular territory," 
than to the inflamed part directly. To illustrate : In the case of orchitis, 
instead of painting the silver solution over the testicle, it is better to 
apply it along the groin and inner face of the thigh, over the course 
of the great vessels. 

Mr. Higginbottom, who is the author of this method of treatment, 
says that " we have no therapeutic agent so safe, powerful, or effica- 
cious, as the nitrate of silver in subduing external inflammation when 
properly applied. It has been invariably successful in my hands for 
nearly the last forty years." Such unstinted praise from so eminent 
an authority deserves our most respectful consideration. As the 
proper application of the remedy is so important, it were better to 
follow literally the method of Mr. Higginbottom : " The affected part 
should be well washed with soap and water, then with water alone, to 
remove every particle of soap, as the soap would decompose the 
nitrate of silver ; then to be wiped dry with a soft towel. The con- 
centrated solution of four scruples of the nitrate of silver to four 
drachms of distilled water is then to be applied two or three times on 
the inflamed surface and beyond it, on the healthy skin, to the extent 
of two or three inches. The solution may be applied with a small 
piece of clean linen, attached to the end of a short stick ; the linen to 
be renewed at each subsequent application. ... In about twelve 
hours it will be seen whether the solution has been well applied. If 
any inflamed part be unaffected, the solution must be immediately re- 
applied." 

The method of Mr. Higginbottom is extremely effective in trau- 
matic erysipelas. The common facial erysipelas rarely requires any- 
thing but the simplest application. The concentrated solution of ni- 
trate of silver should be thoroughly applied to malignant carbuncle of 
the lip, and to the adjacent healthy skin for a short distance. The pit- 
ting of small-pox may be prevented by rupturing each pustule and in- 
serting into it a sharply-pointed pencil of the nitrate of silver. Ac- 
cording to Mr. Higginbottom, the. same result may be accomplished, 
and with greatly less labor, by applying his solution in the manner 
above indicated. 

The solution of nitrate of silver in nitric ether (3ij — § j) is recom- 
mended by Fox in the chronic forms of erythema, eczema, psoriasis, and 
ringworms. Indolent idcers, discharging sores with flabby granula- 
tions, are improved in character and made to heal by application of 
Higginbottom's concentrated solution, or of solid caustic. 

Ulceration of the cervix uteri, endo-cervicitis, granular cervicitis, 
endo-metritis, are effectively treated by nitrate of silver applications. 
The solid caustic may be quickly brushed over the mucous membrane, 
or a concentrated solution may be applied with a suitable " applicator." 



SILVER. 267 

There is no doubt that solid caustic may be applied with safety in 
chronic cases to the interior of the uterine cavity, after preliminary 
dilatation of the cervical canal. This is a most effective treatment, 
but injury is often done by over-stimulation and too prolonged con- 
tact of the caustic. Induration of the cervix and narrowing of the 
cervical canal are sometimes produced by injudicious use of the solid 
caustic. That troublesome affection, pruritus of the vulva, may often 
be removed, even when due to pregnancy, by washing the neck, and 
the cervical canal so far as it is accessible, with a strong solution of 
the nitrate of silver (3 j — 3 j). When the pruritus is due to a vesic- 
ular eruption on the genitals, the application should be made to the 
affected part. Gonorrhoea (vaginal) of the female is most quickly 
removed by applying through the speculum, and to every part of the 
canal, a concentrated solution of silver nitrate (3 j — 3 j). In the male, 
gonorrhoea, at its first appearance, may sometimes be aborted by a 
strong injection ( 3 j — 3 j), but unfortunately the period is usually 
past when this violent practice may be advised. Weak solutions (gr. 
j — grs. v — 3 j) are, as a rule, more efficient, as they are unquestionably 
safer. Cauterization of the prostatic part of the urethra was at one 
time vulgarized in the treatment of spermatorrhoea by the influence of 
Lallemand, but this dangerous practice is rarely necessary. The au- 
thor coincides with Mr. Furneaux Jordan in the expression of the be- 
lief that a vesicating solution of nitrate of silver applied to the peri- 
naeum is as generally useful and, of course, entirely without danger. 

Solutions of nitrate of silver are much used in ophthalmic and au- 
ral surgery. To granular lids, a strong solution (3j — 1 j) is ap- 
plied ; to acute conjunctivitis, a weak solution (gr. j — grs. iv — | j ); 
but generally ophthalmologists prefer the zinc and copper salts in the 
treatment of these affections. The incautious use of silver salts, when 
there are corneal ulcers, may result in unsightly deposits and opaci- 
ties. Otorrhoea, eczema of the external auditory meatus, and chronic 
inflammation of the external ear, may be cured by silver solutions 
properly applied. A commencing furuncle of the external canal may 
sometimes be aborted by application of Mr. Higginbottom's solution.. 

The stains made by nitrate of silver on fabrics or on the hands 
may be removed as follows : Moisten the spots and drop upon them 
a few drops of tincture of iodine, and wash with a solution of hyposul- 
phite of soda ( 3 ss — 3 j). These stains may also be removed by 
washing them with the following solution : Cyanide of potassium, 
3 ijss ; iodine, grs. xv ; water, \ iij. 

Besides the above-mentioned external applications of nitrate of sil- 
ver, this salt is also used according to the method of Luton, entitled 
"parenchymatous substitution." This consists in injecting, with a 
hypodermatic syringe, a few drops of a concentrated solution into the 
parenchyma of organs — an irritant injection. Cystic tumors (wens), 



268 AGENTS INCREASING WASTE. 

small fatty tumors, abscesses, and hydrocele, may be cured by inject- 
ing five to ten drops of a strong solution (3j — 3 ij). In the case of 
cysts and hydrocele, the contents may be allowed to escape through 
the needle, and then the irritant solution be injected. More or less 
active inflammation follows, and the sac, after a variable stage of sup- 
puration, becomes entirely obliterated. 

Old and intractable cases of sciatica that resist other means, includ- 
ing hypodermatic injection of anodynes, are sometimes permanently 
relieved by injecting deeply into the neighborhood of the affected 
nerve ten to twenty drops of a solution of nitrate of silver. Suppura- 
tion usually follows j and the local inflammatory process terminates the 
previously-existing nerve-lesion (parenchymatous substitution). 

Authorities referred to : 

Bartholow, Dr. Roberts. Manual of Hypodermatic Medication, fourth edition, arti- 
cle, Irritant Injections. 

Bogolowskt, Dr. VirchovPs Archiv fur pathologische Anatomic, vol. xlvi, 1869, 
p. 409. 

Fox, Dr. Tilbury. On Diseases of the Skin, second edition, 1873. 

Fox, Dr. "Wilson. On Diseases of the Stomach, revised edition, London and New 
York, 1872, pp. 93, 142, 179. 

Higginbottom, John, F. R. S. The Practitioner, vol. ii, p. 34. 

Jordan, Fcrneaux. The Practitioner, vol. ii, p. 74. 

Reynolds, Dr. Russell. On Epilepsy, London, 1861, p. 333. 

Sieveking, Dr. Edward H. On Epilepsy, second edition, London, 1861. 

Scattergood, Dr. Thomas. British Medical Journal, May 20, 1871. 

Cuprum. — Copper. Cuivre, Fr. ; Kupfer, Ger. 

Cupri Acetas. — Acetate of copper. Deep-green, prismatic crystals, 
yielding a bright-green powder, efflorescent on exposure to air, odor- 
less, having a nauseating, metallic taste and an acid reaction. Soluble 
in 15 parts of water, and in 135 parts of alcohol at 60° Fahr. Dose, 

g r - -iV— g r - i- 

Cupri Sulphas. — Sulphate of copper. Blue vitriol. In blue crys- 
tals, slightly efflorescent in the air, and soluble in 2 6 water at 60° 
Fahr. Ammonia throws down from the solution a precipitate, which 
is wholly dissolved when the alkali is added in excess. Dose, gr. 
i— gr. ss. 

Cuprum Ammoniatum. — Ammoniated copper. (Not official.) A 
deep, azure-blue powder, having an ammoniacal odor, and a styptic, 
metallic taste. It is soluble in water. Dose, gr. \ — gr. j. 

Antagonists and Incompatibles. — Alkalies and their carbonates, 
lime-water, mineral salts (except the sulphates), iodides, and most 
astringent vegetables, are chemically incompatible with the salts of 
copper. In cases of poisoning, white of eggs and milk should be given 
freely, but evacuation of the contents of the stomach is necessary, for 
the albuminate of copper is not devoid of toxic power. The most 



COPPER. 269 

effective chemical antidote is said to be the ferrocyanide of potassium, 
forming the insoluble ferrocyanide of copper. Magnesia has also been 
proposed, but it should not be relied on to the exclusion of albumen 
and ferrocyanide of potassium, nor should any antidote be used with- 
out evacuating the stomach contents by emetics or the stomach-pump. 

Synergists. — The salts of lead, tin, zinc, mercury, silver, gold, 
favor the therapeutic action of the copper-salts. All of these agents 
agree in this : they promote waste, and affect the functions of the nerv- 
ous system secondarily. All unfavorable hygienic conditions, which 
depress the functions of the body, increase the activity of the copper- 
salts. 

Physiological Actions. — The salts of copper have a styptic, me- 
tallic taste. When a poisonous dose of a copper-salt has been taken 
the following symptoms, referable to the digestive organs, appear : A 
strong metallic taste, burning and constriction of the throat, increased 
flow of saliva, burning pain at the epigastrium, with griping and colic- 
pain of the intestines, nausea and vomiting. The vomited matters 
have usually a bluish or greenish color, and the intestinal evacuations, 
which begin in a few minutes after the poison has been swallowed, are 
dark-greenish and frequently bloody. These are the symptoms pro- 
duced by the irritant poisons, and have no special characters, except, 
it may be, the color of the evacuations. The salts of copper, being 
diffusible substances, quickly enter the blood, and the systemic symp- 
toms which follow are referable to the nervous system and the organs 
of excretion. In the blood, as is the case with the other metallic poi- 
sons, copper probably exists in the form of an albuminate in close re- 
lation to the red blood-globules. The breathing becomes short, hur- 
ried, and labored ; the pulse small, quick, and weak ; the skin cold 
and perspiring, and restlessness, headache, trembling, cramps, vertigo, 
and stupor, are followed by convulsions (clonic or tetanic), paralysis, 
and insensibility. 

Inhalation of cupreous fumes, as in certain occupations in the arts, 
the slow introduction of small quantities, as occurs sometimes from 
cooking acid fruits in copper vessels, or the prolonged medicinal ad- 
ministration of moderate doses of a copper-salt, will produce the symp- 
toms of chronic or slow poisoning. When inhaled, the symptoms first 
observed are those of bronchial irritation and bronchial catarrh (Hirt). 
Internally administered, a gastro-intestinal catarrh is produced, epigas- 
tric pain is experienced, nausea, vomiting, colic, tenesmus, and dysen- 
teric discharges, and complete anorexia occur. The loss of appetite, 
and the interference with digestion, as well as the injury done to the 
red blood-globules, impair the strength and increase the waste of the 
tissues. A purplish line along the margin of the gum has been ob- 
served, salivation and ulceration of the gums not unfrequently occur, 
and occasionally jaundice is present as one of the symptoms. As re- 



270 AGENTS INCREASING WASTE. 

gards the nervous system, headache, muscular trembling, paresis of the 
limbs, and sometimes paralysis, altered sensations, defects of co-ordi- 
nation, impaired mind, result. These nervous symptoms, with bron- 
chial and gastro-intestinal catarrh, are usually grouped together in the 
case of chronic cupreous poisoning in artisans. 

Copper is eliminated by the liver, intestinal canal, salivary glands, 
and kidneys. As is the case with the other metallic poisons, copper 
tends to accumulate in the liver. 

Therapy. — The sulphate of copper is one of the remedies some- 
times effective in the vomiting of pregnancy. For this purpose not 
more than one twentieth of a grain, three times a day, is admissible. 
B Cupri sulphat., grs. ij ; aquae destil., | ss. M. Sig.: Six drops a 
dose. 

As sulphate of copper is a very prompt and effective emetic, it is 
frequently resorted to in cases of narcotic poisoning. r> Cupri sul- 
phat., grs. vj ; aquae destil., § ij. M. Sig. : A tablespoonful every fif- 
teen minutes until vomiting ensue. It may be used under the same 
circumstances, but is by no means so desirable an emetic, in croup, as 
subsulphate of mercury. Minute doses of sulphate of copper render 
excellent service in gastro-intestinal catarrh, especially when the bow- 
els are relaxed. $ Cupri sulphat., gr. j ; ext. nucis vom., grs. iv. M. 
Ft. pil. no. xvj. Sig. : One three times a day before meals. When the 
food taken gives rise to colic, which is quickly followed by the incli- 
nation to stool, there should be combined with the above prescription 
one grain of morphine sulphate. When the constipation coexists 
with intestinal catarrh, the following prescription is useful : 3 Cupri 
sulphat., gr. j ; ext. physostigmae, ext. belladonna?, ext. nucis vom., aa 
grs. iv. M. Ft. pil. no. xvj. Sig. : One pill, three times a day, be- 
fore meals. 

The sulphate of copper is a most useful remedy in acute dysentery. 
^ Cupri sulph., gr. ss ; magnesia? sulph., f j ; acid, sulph. dil., 3 j ; 
aquae, § iv. M. Sig. : A tablespoonful every four hours. After the 
acuter symptoms have subsided, the sulphate of copper may be given 
with morphine and opium. Of all the metallic astringents employed 
for this purpose, sulphate of copper is the most effective in chronic 
diarrhoea and chronic dysentery. 3 Cupri sulphat., grs. j ; morphinae 
sulph., gr. j; quininse sulph., grs. xxiv. M. Ft. pil. no. xij. Sig.: One 
pill three times a day. Sulphate of copper is indicated when there are 
present colic-pains, tenesmus, and the stools, partly feculent, contain 
mucus streaked with blood. When tolerance is established, the quan- 
tity of copper in the above formulae may be increased slowly to one 
fourth of a grain. Rarely can more than one twelfth of a grain be 
given to an adult unaccustomed to its use, without causing very un- 
pleasant nausea and depression. 

The dysentery and cholera infantum of children, and the chronic 



COPPER. 271 

enter •o-colitis which sometimes succeeds to measles, are often remark- 
ably benefited by minute doses of sulphate of copper. I£ Cupri sul- 
phat., gr. j ; tinct. opii deodor., gtt. viij ; aquae destil., 3 iv. M. Sig. : 
A teaspoonful every two, three, or four hours, for a child from one to 
two years of age. 

The sulphate of copper is a useful palliative astringent in the diar- 
rhoea of phthisis. It should be combined with opium. 

Kissel regards the salts of copper as curative in pneumonia, and 
the preparation which he prefers is the tincture of the acetate (Phar. 
Ger.). The mortality under this treatment was only 43 per cent. Am- 
moniated copper has been used recently with remarkable success in 
the treatment of facial neuralgia. It must be pushed (Fereol). 

The salts of copper, especially the cuprum ammoniatum, are among 
the numerous remedies employed in the treatment of epilepsy, chorea, 
and hysteria. Successful results have, it is true, been obtained by the 
use of these remedies, but at the present time they are rarely employed. 

External Uses. — The salts of copper do not act very energeti- 
cally on the unbroken integument. Applied to wounds they are as- 
tringent — that is, they combine with albumen, contract the tissues, 
and coagulate the blood. A crystal of sulphate of copper may be used 
to arrest bleeding from small wounds, e. g., from leech-bites. Indolent 
ulcers with flabby granidations can be stimulated to a renewed and 
more healthy activity by touching the affected surface with a crystal 
of sulphate of copper, or by frequent application of a solution (grs. ij 
— grs. x — I j). The following is an excellent injection in gonorrhoea 
after the acute stage : t> Cupri sulph., grs. iv ; morphinae sulph., grs. 
viij ; liq. plumbi subacetat., 3 j ; aquae rosae, 1 iv. M. Sig. : As an 
injection. In that troublesome affection, granular lids, the sulphate 
of copper may be rubbed over the everted lid once a day with advan- 
tage. The application gives great pain, and is immediately followed 
by intense hyperaemia, which, however, subsides in a few hours, leav- 
ing the conjunctiva in much better condition than before. 

In scabies, a solution of sulphate of copper ( § j — Oj) has been used 
with great success, the lotion being applied after the crusts have been 
thoroughly removed with soap and water. An ointment of acetate of 
copper (grs. x — § 3) is a, very effective application in herpes circinatus 
(ringworm). The following formula has been recommended in menta- 
gra : I> Cupri sulph., 3 j ; zinci sulph., § ss ; aquae laur. -cerasi, § jss ; 
aquae destil. ad § xvj. M. Sig. : Lotion. The acetate and carbonate 
of copper are very effective remedies in tinea sycosis. ^ Cupri carb., 
3 ij ; adipis, J j. M. 

Authorities referred to : 

Hirt, Dr. Ludwig. Die Krankheiten der Arbeiter, erste Abtheilung, p. 79, et seq., 
Breslau, 18*71. 

Hermann, Dr. L. Lehrbuch der experimentellen Toxicologie, Berlin, 1874, p. 209. 



272 AGENTS INCREASING WASTE. 

Gubler, Prof. Adolph. Commentaires Therapeutiques du Codex Ifedicamentarins, 
Paris, 1868, p. 435. 

Nothnagel, Dr. Hermann. Handbuch der Arzneimittellehre, Berlin, 18*70, p. 291. 

Tardieu, Ambroise. Bictionnaire d" 1 Hygiene Publique et de Salubrity deux, edition. 
Paris, 1862, vol. i, article Cuivre. 

Taylor, Dr. A. S. On Poisons, p. 458, et seq. 

Plumbum. — Lead. Plomb, Fr. ; Blei, Ger. 

Plumbi Oxidum. — Oxide of lead. Litharge. In small yellowish 
or orange-colored scales, insoluble in water, but almost wholly soluble, 
with slight effervescence, in dilute nitric acid. The solution is affected 
by potassa, like that of carbonate of lead in the same acid. 

Emplastrum Plumbi. — Lead-plaster. Litharge and olive-oil. 

Plumbi Acetas. — Acetate of lead. Sugar of lead. In colorless 
crystals which effloresce on exposure to the air. It is dissolved by dis- 
tilled water, with a slight turbidness, which is removed by the addi- 
tion of vinegar. With this solution carbonate of sodium produces a 
white, iodide of potassium a yellow, and hydrosulphuric acid a black 
precipitate. Upon the addition of sulphuric acid, vapor is evolved, 
having the smell of vinegar. Dose, gr. ss — grs. v. 

Liquor Plumbi Subacetatis. — Solution of subacetate of lead. A 
colorless liquid of the specific gravity of 1'267. It is decomposed by 
exposure to the air, carbonate of lead being formed. When added to 
a solution of gum it occasions a dense white precipitate. 

Liquor Plumbi Subacetatis Dilutus. — Diluted solution of subace- 
tate of lead. (Solution of subacetate, 3 iij ; distilled water, Oj.) 

Ceratum Plumbi Subacetatis. — Cerate of subacetate of lead. So- 
lution of subacetate of lead, 20 parts ; camphor cerate, 80 parts. 

Plumbi Carbonas. — Carbonate of lead. A white substance in 
powder or pulverulent masses, insoluble in water, but soluble, with ef- 
fervescence, in dilute nitric acid. Potassa added to the solution pro- 
duces a white precipitate, which is wholly dissolved by an excess of 
the alkali. Heat renders it yellow, and, with the aid of charcoal, re- 
duces it to the metallic state. 

Unguentum Plumbi Carbonatis. — Ointment of carbonate of lead. 
(Carbonate of lead, 10 parts ; benzoinated lard, 90 parts.) 

Plumbi Nitras. — Nitrate of lead. In white, nearly opaque, octa- 
hedral crystals, permanent in the air, and of a sweet astringent taste. 
It is soluble in seven and a half parts of cold water, and in alcohol. Its 
solution is precipitated black by hydrosulphate of ammonium, white by 
ferrocyanide of potassium, and yellow by iodide of potassium. 

Plumbi Lodidum. — Iodide of lead. A bright-yellow, heavy, in- 
odorous powder, fusible and volatilizable by heat, and soluble in twelve 
hundred and thirty-five parts of cold, and one hundred and ninety- 
four parts of boiling water. A hot saturated solution, on cooling, de- 
posits the salt in brilliant, golden scales. 



LEAD. 273 

Unguentum JPlumbi Iodidi. — Ointment of iodide of lead. (Iodide 
of lead, 10 parts ; benzoinated lard, 90 parts.) 

Antagonists and Incompatibles. — Natural waters containing 
lime, sulphates, carbonates, carbonic acid, mineral acids and mineral 
salts, vegetable acids, alkalies, iodide of potassium, the vegetable 
astringents in general, albuminous solutions, and the preparations of 
opium, are incompatible. In cases of poisoning by acetate of lead, 
the proper antidotes are the sulphates of soda or magnesia, phosphate 
of soda, milk, and albuminous solutions. Emetics and the stomach- 
pump should be used. 

Synergists. — Cold, digitalis, ergot, veratrum viride, and agents 
acting similarly, favor the influence of acetate of lead over the circu- 
latory system. Copper, mercury, antimony, and remedies promoting 
waste, increase the depressing effects of lead on the nutrition of the 
body. 

Physiological Actions. — The acetate is astringent ; that is, it 
combines with albumen to form compounds, for the most part insolu- 
ble in water and in acids. All the salts of lead are more or less toxic. 
As the acetate, which is most frequently the preparation taken, has a 
sweetish taste, mistakes not unfrequently happen ; but the after-taste 
is decidedly astringent and slightly metallic. As the combination of 
the salts of lead with albumen takes place on contact, this action en- 
sues in the mouth in part, and is completed in the stomach. Any 
part of the lead reaching the intestinal canal must be converted into 
the insoluble sulphide. A very large quantity of the acetate of lead 
is required to produce a fatal effect ; not less than an ounce. When 
swallowed in this quantity and retained, it produces intense gastric 
irritation, sometimes choleriform symptoms, numbness, paralysis, coma, 
collapse. Owing to the fact that so large a quantity of acetate of 
lead will be rejected by vomiting, cases of acute poisoning rarely 
terminate fatally, and are infrequent. On the other hand, chronic poi- 
soning by lead is very common, owing to the use of cosmetics and 
hair-dyes containing lead, the use of food preserved in tin cans sol- 
dered with lead, and to the contamination of drinking-water. Yery 
rarely is the acetate of lead so persistently used in medical practice as 
to produce toxic symptoms. 

When lead is slowly introduced into the organism in small doses, 
the first symptoms usually observed are loss of appetite, failure of 
strength, more or less wasting, paleness of the face and of the integu- 
ment generally, and constipation. The joints become the seat of 
rheumatoid pain ; there is dry colic, the pain of which is assuaged by 
pressure ; and the muscles of the abdominal parietes are also seized 
with neuralgia. At the same time the liver diminishes in size, the 
abdominal fat disappears, the intestines are contracted, the belly is 
drawn in toward the spinal column. Coincidently with the contrac- 
18 



274 AGENTS INCREASING WASTE. 

tion of the liver, the skin assumes an icteroid hue, the conjunctivae be- 
come yellow, and the urine is tinged with the biliary coloring matters. 
At this time may be observed the so-called " blue line " along the 
margin of the incisor teeth — a slate-colored line, probably due to a 
deposition of the sulphide of lead, and found only, according to the 
author's experience, in those not accustomed to the use of a tooth- 
brush. The mucous membrane of the lips and mouth has often a blu- 
ish or slate-colored tint, and sometimes brownish pigment-deposits are 
seen on the lips near the teeth, and on the gums. Albuminuria may 
exist at this time, but it is commonly present further on in the history 
of these cases. Lead may cause that condition of hyperalbuminosis 
which eventuates in albuminous urine, but probably it in most cases 
hastens the development of changes in the kidneys already impending. 
As Garrod has conclusively shown, the use of lead, or its slow intro- 
duction through unknown channels, hinders the conversion of uric 
acid into urea, and favors the deposition of urate of soda about the 
joints : hence the arthritic pains which accompany the other symp- 
toms of chronic lead-poisoning, and the intimate relation of the pres- 
ence of lead in the organism and gouty attacks. 

The symptoms thus far sketched are chiefly those due to the influ- 
ence of the agent over the oxidation processes of the body in general. 
It is necessary now to consider the action of lead on the nervous sys- 
tem. Lead gastralgia is an early symptom, in part due to the fact 
that the metal acts directly on the nerves of the stomach, but it is also 
a symptom of the action of the poison on the central nervous system. 
Lead arthralgia, already referred to, is frequently an affection of the 
intra-muscular nerves, and has its seat more especially in the flexor 
muscles. The swelling of the joints and the joint-pains are doubtless 
due, as already explained, to the deposition of the urates in the joints 
themselves, but the term arthralgia is used to describe that form of 
pain about the joints produced by lead. Impaired sensibility to touch 
is also one of the phenomena of lead-poisoning. This lead-ancesthesia 
is found about the neck, chest, the forearms (their palmar face), hands, 
and fingers, and is symmetrically distributed on the two sides. An- 
aesthesia of the optic {amaurosis) is also a result of the direct action 
of lead, but dimness of vision and a sluggish pupil may also be due to 
the albuminuria which is so frequently present. Paralysis of the com- 
mon extensors of the fingers and of the supinators, while the power of 
the flexors and pronators is much less diminished, constitutes that 
very striking symptom of lead-poisoning, " the drop-wrist." When 
the arms are raised the hands drop forward and to the palmar face 
of the forearm, from an inability of the extensors to hold them up. 
Paralysis may invade the laryngeal muscles, producing aphonia. 
Sometimes the paralysis has the hemiplegic form, and, still more 
rarely, the paraplegic. At the beginning of the paralysis, the mus- 



LEAD. 275 

calar irritability is preserved, but it soon lessens, and is lost finally, 
so that the muscles cease to respond to the faradic current. For some 
time after the induction current fails to excite contraction, muscu- 
lar movements may be obtained by a slowly- interrupted galvanic 
current. 

Death may result from the saturnine cachexia, by the gradual fail- 
ure of nutrition, and by the extension, finally, of the muscular paraly- 
sis to the muscles of respiration. Death may occur much earlier, by 
the development of those symptoms to which has been applied the 
term lead-encephalopathy — a form of disease characterized by delirium 
and convulsions, ending in fatal coma. 

Lead is very fatal to the life of the foetus, and women the subjects 
of the saturnine cachexia abort early, or produce stillborn children. 

After death, lead is found in various organs of the body, and rela- 
tively in large amount in the brain. It is also largely deposited in the 
substance of the affected muscles and nerves, and the destruction of 
the Hallerian irritability, the disappearance of the striation and the 
granular condition of the nerves, are probably due to the direct action 
of the metal. Lead, also, like the other minerals, tends to accumulate 
in the liver ; much of it is probably eliminated by the intestinal glands 
and skin, and some passes out by the kidneys. 

The treatment of lead-poisoning is prophylactic and curative. 
Among the former are, personal cleanliness, frequent bathing, the use 
of sulphuric-acid lemonade, the habitual employment of milk in large 
quantity as a food, and the avoidance of all sources of contamination. 
Among the curative measures must be placed first, large doses of the 
iodide of potassium, purgative doses of Epsom salts, and sulphur-baths. 
The affected muscles should be early faradized to prevent atrophic 
changes. When they fail to respond to a faradic current, a slowly- 
interrupted galvanic current should be used, and after a time the fara- 
dic irritability may be recovered. 

Therapy. — Acetate of lead is one of the astringent remedies em- 
ployed to arrest hmmatemesis. It is more especially adapted to the 
vomiting of blood which accompanies gastric ulcer. This salt exercises 
a favorable influence over the course and progress of gastric ulcer ; it 
allays pain and local inflammation, and modifies the ulcerated surface. 
In chronic gastric catarrh with gastralgia and pyrosis, it has given 
great relief. Notwithstanding the chemical incompatibility, it may be 
advantageously combined with morphine in painful stomach-affections. 
The most frequent use of the acetate of lead in gastro-intestinal dis- 
orders is in the treatment of the various forms of diarrhoea. It is an 
excellent remedy in the summer diarrhoea of children. 1^ Plumbi 
acetat., grs. viij ; acid, acetic, gtts. vj ; tinct. opii deodor., gtts. iv ; 
aquae destil., f j. M. Sig. : A teaspoonful every two, three, or four 
hours for a child two years of age. In choleraic diarrhoea, acetate of 



276 AGENTS INCREASING WASTE. 

lead is one of the most useful astringents : 1^ Plumbi acetat., grs. 
xxiv ; pulv. opii, grs. xij ; pulv. camphorae, 3 ss ; sacch. alb., q. s. Ft. 
pulv. no. xii. Sig. : One powder every hour or two. It is sometimes 
preferable to administer the acetate of lead in solution, when the for- 
mula above given for children may be used in corresponding dose for 
adults. Probably, the most generally successful remedy for the diar- 
rhoea of phthisis is a pill containing equal parts of acetate of lead and 
opium. The diarrhoea of typhoid may also be restrained by acetate 
of lead and opium ; but generally bismuth is more suitable than acetate 
of lead. In acute and chronic dysentery lead is often a useful astrin- 
gent. Enemata of lead and morphine (5 Plumbi acetat., grs. iv ; 
morphinae acetat., gr. ss; aquae fervid., | j) allay the tenesmus of acute 
dysentery. Enemata of corresponding strength to age, of the same 
composition, are very useful in the cholera infantum of children. 

Although the salts of lead undergo important chemical changes in 
the intestinal canal, and are probably very much modified in composi- 
tion before they enter the blood, yet there is no doubt about their 
power to affect remote parts. The value of acetate of lead in various 
forms of haemorrhage has been attested by an immense clinical expe- 
rience. Thus, in haemoptysis, it is a most useful haemostatic. Careful 
observations on a case of severe and protracted pulmonary haemorrhage 
demonstrated that five grains of the acetate, every three hours, exer- 
cised a remarkable influence over the arterial tension and the action 
of the heart. Its effects are similar to those of digitalis : it slows the 
action but increases the power of the heart, while at the same time it 
elevates the tension of the arterioles. The astringent is, however, a 
dynamical and not a chemical action, doubtless. There is, therefore, 
a fitness in the prescription of Oppolzer for caseous pneumonia : Tji Inf. 
digitalis, 3 iv ; plumbi acetat., 3 j ; tinct. opii, 3 j. M. Sig. : A table- 
spoonful twice a day. A similar combination is serviceable in haemop- 
tysis: fy Plumbi acetat., 3i] ; pulv. digitalis, 3] ; pulv. opii, grs. x. 
M. Ft. pil. no. xx. Sig. : One every four hours. 

By virtue of its astringent action acetate of lead restrains secretion, 
and hence its utility in bronchorrhoea. It is also serviceable in humid 
asthma and whooping-cough. 

Formerly acetate of lead was used to quiet the action of the heart 
in hypertrophy -, and to favor coagulation of the blood in the case of 
internal aneurism. It might often be usefully employed in these af- 
fections now. 

In prescribing the preparations of lead for internal use, the danger 
of producing plumbism should not be overlooked. When it is used 
for any considerable period, the gums should be frequently inspected, 
and on the slightest appearance of a blue line, or on the occurrence of 
constipation and abdominal pain, the remedy should be at once discon- 
tinued. 



LEAD. 277 

External Application of Lead Preparations. — The uses of 
lead preparations for external diseases are numerous and important. 
An excellent application to burns is white-lead paint — carbonate of 
lead and linseed-oil. This may be objectionable when the surface is 
very large, lest a dangerous amount of absorption take place, but for 
burns of small extent it is safe and gives great relief. The surface of 
the burn is thickly coated with the paint. Lead-lotion (liquor plumbi 
subacetatis dilutus) is a good application to eczema when there is much 
weeping. The following ointment has been recommended in this af- 
fection : $ Plumbi acetat., 3 ss ; camphor, pulv., grs. xv ; ol. amyg- 
dal., § ij ; cerre flavse, § j. M. Ft. cerat. An excellent formula for 
eczema, when there are great heat and redness, and profuse discharge, 
consists of liquor plumbi subacetatis, § j ; glycerine, § ss ; and cherry- 
laurel water, 3 iijss. The following formula is recommended by Fox 
in eczema and lichen: 3 Acid, nitrici dil., 3 ss ; plumbi acetat., grs. v ; 
aqua3, | vj. M. In erythema the carbonate of lead is used with advan- 
tage : I£ Plumbi carb., grs. iv ; glycerinse, 3 j ; cerat. simplicis, § j. M. 
In impetigo the following : fy Plumbi acetat., grs. xv ; acid, hydro- 
cyan, dil., ttl xx ; alcoholis, 3 ss ; aquae, 3 vss. M. 

Lead lotions are much used to cure muco-purulent and purulent 
discharges from the ear, the vagina, and the urethra. They may be 
employed at any stage, and the existence of inflammation does not 
contraindicate their use. The following is a useful formula for gonor- 
rhoea: fy Liq. plumbi subacetat. dil., 3 iv ; zinci sulphat., grs. viij. M. 
Sig. : As an injection. A chemical change, of course, takes place, but 
clinical experience is in favor of the combination. 

The ointment of the iodide of lead is often a useful application to 
enlarged lymphatic glands and to enlarged spleen. It is also employed 
with benefit in cases of chronic eczema, porrigo, and psoriasis. 

A solution of the nitrate of lead in pure glycerin (grs. x — 3 j) is 
an effective application to fissured nipples. It need hardly be re- 
marked that the nipple should be well w r ashed before the child is per- 
mitted to suck. Nitrate of lead in form of powder, dusted over the 
unhealthy granulations, gives great relief, and hastens the healing of 
onychia. 

Authorities referred to : 

Garrod, Dr. A. B. The Nature and Treatment of Gout, London, 1869. 

Gusserow, Prof. Dr. Archiv fur pathologische Anatomie, xxi, 443. 

Hermann, Dr. L. Lehrbuch der experimentellen Toxicologic, Blcisake, p. 196, 
et seq. 

Hirt, Dr. Lcdtvig. Die Krankheiten der Arbeiter, p. 92, et seq. 

Nothnagel, Dr. Hermann. Handbuch der Arzneimittellehre, Blei-Praparate, p. 268, 
et seq. 

Rosenstein, Prof. Dr. Archiv fur pathologische Anatomie, xxxix, 1 und 174. 

Schmidt's Jahrbucher der gesammten Medicin, vol. cxliv, p. 279. Mittheilungen 
ueber Bleivergiftung, von L. Pappenheim ; E. Clapton ; A. Bobiene ; E. Buchner ; Alois 



278 AGENTS INCREASING WASTE. 

Gruber; Stamm; Bucquoy; A. Gubler ; Nicaise ; E. Meyer; Murchison; Paleari ; Pan- 
thiel. 

Second Annual Report of the State Board of Health of Massachusetts, 1871, p. 21. 

Tardieu, Ambroise. Diciionnaire d' 'Hygiene publigue et de Salubrite, deux, edition, 
tome troisieme, p. 334. 

Zincum. — Zinc. Zinc, Fr. ; Zirik, Ger. 

Zinci Oxidum. — Oxide of zinc. A yellowish -white powder, in- 
soluble in water, but soluble in dilute sulphuric and muriatic acids 
without effervescence. The solutions, when neutral, yield white pre- 
cipitates with ferrocyanide of potassium and hydrosulphate of ammo- 
nium. Dose, gr. ss — grs. v. 

Zinci Carbonas Precipitatus. — Precipitated carbonate of zinc. A 
light, white powder, odorless and tasteless, and insoluble in water or 
alcohol. 

Ceratum Zinci Carbonatis. — Cerate of carbonate of zinc. (Not 
official.) (Carbonate, J ij ; ointment, 3 x.) 

Zinci Sulphas. — Sulphate of zinc. In colorless crystals, which ef- 
floresce on exposure to air. It is soluble in water, and the solution 
affords white precipitates with ammonia, chloride of barium, ferrocya- 
nide of potassium, and hydrosulphate of ammonium. The precipitate 
thrown down by ammonia is wholly soluble in an excess of the alkali. 
Dose, gr. J— grs. vj. 

Zinci Acetas. — Acetate of zinc. In micaceous crystals, which ef- 
floresce in a dry atmosphere. It is soluble in 3 parts of water, and its 
solution yields white precipitates w T ith ferrocyanide of potassium and 
hydrosulphate of ammonium. The salt is decomposed by sulphuric 
acid, with the escape of acetous vapors. Dose. gr. ss — grs. ij. 

Liquor Zinci Chloridi. — Solution of chloride of zinc. An aqueous 
solution, containing about 50 per cent of the salt. 

Zinci Chloridum. — Chloride of zinc. A white deliquescent salt, 
wholly soluble in water, alcohol, and ether. Its aqueous solution 
yields with nitrate of silver a white precipitate, insoluble in nitric acid. 
(These preparations are for external use only.) 

Zinci Valerianas. — Valerianate of zinc. A w r hite anhydrous salt, 
in the form of pearly scales, having a faint odor of valerianic acid, and 
a metallic styptic taste. It dissolves in one hundred parts of water, 
and in forty of alcohol of the specific gravity of 0'833. Dose, gr. \ 

— gr. J- 

TJnguentum Zinci O^Yfo'.-r-Ointment of oxide of zinc. (Oxide of 
zinc, 20 parts ; benzoinated lard, 80 parts.) 

Antagonists and Incompatibles. — Lime-water, the alkalies and 
their carbonates, nitrate of silver, and the vegetable astringents, are 
incompatible with zinc-salts. The acetate of lead is also incompati- 
ble, but a solution containing sulphate of zinc and acetate of lead, not- 
withstanding the double decomposition which ensues, is an effective 



ZINC. 279 

injection in gonorrhoea. With valerianate of zinc, acids, many of the 
metallic salts, soluble carbonates, and vegetable astringents, are incom- 
patible. The antidotes to be used in cases of poisoning by the zinc- 
salts are lime-water, mucilaginous drinks, milk, tannic acid, the carbon- 
ated alkalies, common soap, etc. 

Synergists. — The mercurial, silver, antimonial, and copper prepa- 
rations favor the action of the zinc-salts. 

Physiological Actions. — The preparations of zinc are active in 
proportion to their solubility and power of diffusion. The chloride, 
the sulphate, and the acetate, are the most active, and in the order in 
which they are placed ; the carbonate and the oxide being insoluble, 
have very feeble diffusive power, and possess consequently very slight 
activity. The chloride is a very active escharotic. Applied to the 
denuded integument, it sets up decided inflammation, and produces an 
intense burning pain, followed by sloughing. Owing to its great affin- 
ity for water and power of combination with albumen, it penetrates 
deeply and widely, and the eschar which it produces is thick, hard, 
and white. The dried sulphate of zinc (deprived of its water of crys- 
tallization by heat) is also feebly escharotic when applied to an open 
wound. Solutions of the sulphate and acetate act locally as astringents 
by combining with albumen. 

The soluble salts of zinc have a styptic metallic taste, which is very 
disagreeable. The sulphate of zinc is a very prompt and efficient 
emetic, acting without much preliminary nausea, and without much 
constitutional depression. It is a specific emetic ; it acts to produce 
emesis when injected into the veins. Long-continued use of the sul- 
phate, even in small medicinal doses, may excite ulceration of the mu- 
cous membrane. The oxide and carbonate, although insoluble and in- 
active, slowly produce systemic effects. The chloride is a powerful 
irritant poison, causing heat and a sense of constriction of the throat, 
a strong metallic taste, burning at the stomach, nausea, vomiting, 
great depression of the pulse, coldness of the surface, cold sweat, 
cramps of the legs, etc. The mind is unaffected. In a few instances 
nervous symptoms have followed, besides the cramps, and in one no- 
table case there was loss of the senses of taste and smell. 

All of the salts of zinc, when long continued, may produce a train 
of symptoms not unlike those caused by lead, viz., emaciation, pallor, 
loss of strength, constipation and colic, muscular weakness and trem- 
bling, paralysis, etc. The oxide in large doses, and used for a long 
period, has produced wasting, a fetid breath, gastro-intestinal catarrh, 
weakness, and feeble mind. 

The zinc-salts most probably exist in the blood in the form of al- 
buminate, and in close relation to the red blood-globules. They mani- 
fest much less tendency to accumulate, and are excreted much more 
rapidly than mercury, lead, and copper. They diffuse out of the blood 



280 AGENTS INCREASING WASTE. 

chiefly by the liver and intestinal glandular apparatus, and are found 
in great quantity in the faeces. To a slight extent they are also ex- 
creted by the kidneys. 

Therapy. — The sulphate of zinc is much employed as an emetic in 
cases such as narcotic poisoning, where prompt and efficient action is 
necessary. Six grains will generally prove sufficient. It may be re- 
peated every fifteen minutes, well diluted with water, until emesis oc- 
curs. It was formerly much employed as an emetic in croup, but now 
tartar-emetic, but especially the subsulphate of mercury, is preferred. 

The oxide of zinc is an excellent remedy for gastralgia. It is indi- 
cated also in the following state of things : pain after taking food, 
nausea, intestinal pain, succeeded by prompt alvine discharges, the 
faeces being made up largely of undigested food. From five to ten 
grains mixed with aromatic powder and combined with morphine, if 
need be, may be given before each meal. In the summer diarrhoea of 
children, it is a very efficient remedy. It may be administered with 
bismuth and pepsin. $ Bismuthi subnitrat., 3 j — 3 ij ; pepsinae 
sacch. (Sheffer's), 3 ss; zinci oxidi, grs. vj — grs. xij. M. Ft. pulv.no. 
xii. Sig. : One poivder every four to six hours. In the chronic diar- 
rhoea both of children and adults the oxide of zinc (from two to ten 
grains) is serviceable under the same circumstances in which bismuth 
is presumed to be indicated, but it is a less pleasant remedy in action 
than the latter. The sulphate (gr. ss — grs. ij) often gives great relief 
in that form of dyspepsia which is the cause of oxaluria. In small 
doses, the sulphate, like most of the mineral remedies of this group, 
increases for a time the appetite and digestive capacity, but this effect 
is soon succeeded by gastro-intestinal catarrh, nausea, and loss of appe- 
tite. The sulphate, as well as the oxide, is an astringent ; it arrests 
the peristaltic movements and causes constipation, and is therefore 
an appropriate remedy in chronic diarrhoea and chronic dysentery. 
In its action and results it is similar to but less efficient than sulphate 
of copper. It may be combined with opium and ipecacuanha : 1^ 
Zinci sulphat., pulv. opii, pulv. ipecac, aa grs. xij. M. Ft. pil. no. xij. 
Sig. : One pill three or four times a day. 

The zinc preparations possess undoubted efficacy in certain disorders 
of the thoracic organs. The night-siceats of phthisis are often pre- 
vented by a pill of oxide of zinc and extract of belladonna (three 
grains of the former and half a grain of the latter) given at bedtime. 
The zinc is serviceable without the belladonna, but the combined action 
is more efficient. The sulphate of zinc, by virtue of its astringency, 
has been prescribed in bronchorrhcea, but other agents are now pre- 
ferred. The oxide of zinc is a serviceable prophylactic against the 
recurrence of the attacks of spasmodic asthma. It is also one of the 
numerous remedies which has been used with a varying degree of suc- 
cess in whooping-cough : ^ Zinci oxidi, 3 j ; ext. belladonnae, grs. v. 



ZINC. 281 

M. Ft. pil. no. xx. Sig. : One pill three times a day as a prophylactic 
for asthma, and as a remedy for whooping-cough. The sulphate of 
zinc (gr. \ — gr. j) and extract of belladonna (gr. \ — gr. ss) may be 
used in combination for the relief of the same cases. It is highly 
probable that the sulphate of zinc, being more soluble, is much more 
efficient in the treatment of these neuroses of the digestive organs than 
the oxide. 

The preparations of zinc exert an influence upon the nervous system 
which has been and is called antispasmodic. In certain disorders of 
the nervous system, of which the chief manifestations are spasm and 
convulsion (clonic), they are sometimes very serviceable. Much has 
been said for and against the oxide of zinc as a remedy for epilepsy. 
A few cases are improved by it ; in the great majority it fails utterly. 
The author expresses with diffidence his conviction that this remedy 
is most useful in those cases in which the peripheric irritation has its 
origin in the stomach ; it acts by allaying irritability of the terminal 
filaments of the pneumogastric, and probably also by removing a dis- 
eased state of the gastric mucous membrane. Epileptiform vertigo 
and epileptiform angina pectoris, when they arise (as they not unfre- 
quently do) from gastric disorder of some kind, are sometimes cured 
by the oxide of zinc. The so-called nervous headache of hysterical 
women, nervous cough, and aphonia, due to uterine and ovarian irri- 
tation, are often relieved by the valerianate of zinc. Sulphate of zinc 
is one of the numerous remedies for chorea, acting in a manner similar 
to arsenic, but inferior to this agent in curative power. In neuralgia 
due to reflex irritation from the female pelvic organs, the preparations 
of zinc, notably the valerianate, are often extremely beneficial. r> 
Zinci valerianat., 3 j ; ext. gentianse, 3 j ; ext. nucis vom., grs. v. M. 
Ft. pil. no. xx. Sig. : One pill three or four times a day. In chronic 
alcoholismus, to relieve the trembling, to diminish the appetite for 
strong drink, and to relieve the gastric catarrh, the oxide of zinc is 
very useful : t^ Zinci oxidi, 3 j ; piperin., 3j. M. Ft. pil. no. xx. 
Sig. : One pill three or four times a day. 

External Uses. — The author has personal knowledge of several 
cases of caries cured by the injection of Villate^s solution. The fol- 
lowing is the composition of this fluid : Sulphate of copper, sulphate 
of zinc, of each 15 parts ; solution of subacetate of lead, 30 parts ; 
vinegar, 200 parts. The sinus or sinuses leading to the carious bone 
should be thoroughly injected with the solution. It need hardly be 
remarked that this treatment would not remove a sequestrum. 

An excellent caustic for the destruction of lupus, epithelioma, and 
unhealthy ulcers, is the dried sulphate of zinc, which may be freely 
dusted over the affected surface. A superficial slough forms, the sepa- 
ration of which may be aided by a poultice. The most efficient escha- 
rotic consistent with safety is the chloride. No danger is to be ap- 



282 AGENTS INCREASING WASTE. 

prehended from its absorption, and the strength of the application 
may be easily regulated. For the destruction of malignant growths, 
chloride of zinc is applied of varying strength, by the admixture of 
different proportions of flour, or better, of powdered althea-root, so as 
to form a paste, sufficient water being added. One part of the chloride 
to two, three, four, or five parts of flour are the proportions advised 
by Dr. Can quoin. Instead of flour, the chloride may be mixed with 
anhydrous sulphate of lime. A very convenient and useful mode of 
applying chloride of zinc is, to mix it, while in a finely-powdered state, 
with its weight of gutta-percha melted with as little heat as possible. 
The mixture may be molded into any desired shape. The so-called 
" caustic arrows " are nothing more than chloride-of-zinc paste, dried 
and cut into arrow-like slips. These are inserted into the malignant 
growth, usually at its base, in order to separate it from the healthy 
tissues. 

The salts of zinc are useful applications to certain forms and stages 
of skin-diseases. In eczema, during the secretory stage, the following 
may be used : 3 Zinci oxidi, 3 ij ; glycerinae, 3 ij ; liq. plumbi sub- 
acetat., 3 jss ; aquae calcis ad § vj. M. Sig. : Lotion (Fox). This 
formula is serviceable also in impetigo and herpes. An excellent ab- 
sorbent powder for excoriated surfaces is the following : I£ Corn-meal, 
finely sifted, f iv ; oxide of zinc, J j ; iris powder, § ss ; oil of almonds, 
gtts. x. M. The following is recommended by Neumann in sebor- 
rhea, when there is inflammation : 1^ Zinci oxidi, 3 j ; plumbi car- 
bonat., 3 j ; cetacei, § j ; ol. olivae q. s. ft. ung. Sig. : Ointment. 
In erythema, intertrigo, and eczema, the following lotion is useful : I£ 
Aluminis, 3] ; zinci sulph., grs. x; glycerinae, 3 j ; aquae rosae, |iv. 
M. Sig. : Lotion. For erythema and herpes, the following may also 
be used : ^ Zinci acetat., grs. ij ; aquae rosae, 3 j ; ung. aquae rosae, 
§ j. M. Sig. : Ointment. The ointments of the oxide of zinc and 
the cerate of the carbonate are excellent applications in many of the 
cutaneous affections above named. 

Probably the most efficient means for treating gonorrhoea consists 
in the use of a weak zinc-injection frequently repeated. 1^ Zinci 
chloridi, gr. j ; aquae rosae, I iv — f viij. M. Sig. : As an injection 
^ Zinci sulph., grs. viij ; aquae rosae, § viij. M. Sig. : As an injec 
tion. After the acute symptoms have subsided, the following injec 
tion is very effective : I> Zinci sulphat., plumbi acetat., aa grs. viij 
ammoniae muriat., aluminis, aa grs. iv ; aquae rosae, 5 j. M. Sig. : As 
an injection. 

The sulphate of zinc is very much prescribed by the ophthalmolo- 
gists in conjunctivitis, otorrhcea, etc. It is usually associated with mor- 
phine and atropine. I> Zinci sulphat., grs. ij— grs. viij ; morphinae 
sulph., grs. ij — grs. iv ; atropinae sulph., gr. ss— gr. j ; aquae rosae, f j. 
M. Sig. : For the eye. 



ANTIMONY. 283 



Authorities referred to : 



Fox, Dr. Tilbury. On Diseases of the Skin, second American edition. 

Gubler, Dr. Adolphe. Commentaires Therapeutiques du Codex Medicamentarius. 

Hirt, Dr. Ludwig. Die Kranklieiten der Arbeiter, erster Theil, Breslau, 18*71, p. 97, 
et seq. 

Nothnagel, Dr. Hermann. Handbuch der Arzneimittellehre, p. 281, et seq., Zink- 
Praparate. 

Simpson, Sir James Y. Clinical Lectures on Diseases of Women, American edition, 
1872, p. 195. 

Trousseau et Pidoux. Trait'e de Therapeutique et de Matiere Medicate, eighth edition, 
by Paul. 

"Waldenburg und Simon. Handbuch der allgemeinen und speciellen Arzneiverordnungs- 
Lehre, Berlin, 1873. 

Antimonium. — Antimony. Antimoine, Fr. ; Antimon, Ger. 

Antimonii et Potassii Tartras. — Tartrate of antimony and potas- 
sium. Tartar-emetic. In transparent crystals, which become white 
aad opaque on exposure to the air. It is wholly soluble in twenty 
parts of water. The solution yields no precipitate with chloride of 
barium, or, if very dilute, with nitrate of silver. Hydrosulphuric acid 
causes an orange-red precipitate. A solution containing one part in 
forty of water is not disturbed by an equal volume of a solution of 
eight parts of acetate of lead in thirty-two of water and fifteen of 
acetic acid. Dose, gr. -^ — grs. ij. 

Emplastrum Antimonii. — Antimonial plaster. (Not official. ) 
(Tartrate of antimony and potassium, § j ; Burgundy pitch, 3 iv.) 

Unguentum Antimonii. — Antimonial ointment. (Not official.) 
(Tartrate of antimony and potassium, 100 grains ; lard, 400 grains.) 

Vinum Antimonii. — Wine of antimony. (Tartrate of antimony 
and potassium, 4 parts ; boiling distilled water, 60 parts ; stronger 
white wine to make 1,000 parts.) Nearly two grains to the ounce. 
Dose, niv — 3 ij. 

Mistura GlycyrrMzm Composita. — Compound glycyrrhiza mixture. 
(Brown mixture. Contains extract of glycyrrhiza, paregoric, nitrous 
ether, and wine of antimony. ) Dose, a tea to a tablespoonf ul. 

Syrupus Scillce Compositus. — Compound sirup of squill. Hive- 
sirup. (Squill, seneka, tartar-emetic. Contains about three fourths 
of a grain of tartar-emetic to the ounce.) Dose, tt[ v — 3 j. 

Antimonii Oxidum. — Oxide of antimony. A grayish-white pow- 
der, insoluble in water, but readily and wholly soluble in muriatic or 
tartaric acid. Dose, gr. j — grs. iij. 

Antimonii Sulphidum Purificatum. — Purified sulphide of anti- 
mony. A dark-gray powder, odorless and tasteless, and insoluble in 
water or alcohol. Dose, gr. | — gr. j. 

Antimonii Sulphur atum. — Sulphurated antimony is a reddish-brown 
powder, insoluble in water. Dose, gr. j — grs. v. 

In the remarks which follow, tartar-emetic is the. only antimonial 



284 AGENTS INCREASING WASTE. 

preparation referred to, unless otherwise stated. None of the other 
preparations are employed by modern physicians. 

Antagonists and Incompatibles. — Tannic and gallic acids, and 
vegetable infusions containing them, form an insoluble tannate, and 
are therefore incompatible. Alkalies and the salts of lead decompose 
tartar-emetic. It follows that the proper antidotes to poisoning by 
tartar-emetic are tannic acid and substances containing it. Opium, 
alcohol, ether, etc., and the antispasmodics generally, are physiologi- 
cally antagonistic. 

Synergists. — The mineral substances of this group promote the ac- 
tion of the antimonials ; also the emetics and cathartics, and depress- 
ing remedies generally, as veratrum viride, etc. 

Physiological Actions. — Tartar-emetic has a sweetish, styptic, 
and metallic taste. In small medicinal doses, it excites a sensation of 
warmth in the stomach, followed by nausea, increased flow of saliva 
and buccal mucus, an abundant secretion of the gastric and intestinal 
glandular apparatus, and also of the liver and pancreas. In somewhat 
larger doses — a half-grain to one or two grains — it excites vomiting, 
first of the contents of the stomach, then of gastric mucus, and after- 
ward of mucus and biliary matters. The alvine dejections are more 
fluid and increased in number, and consist at first of fluidified faeces ; 
afterward they are made up of a colored liquid, in which there are 
present biliary matters and some faeces ; and, finally, there appears 
only a colorless or whitish liquid, having flocculi of epithelium floating 
in it, and bearing a striking resemblance to the " rice-water discharges " 
of cholera. 

The gastro-intestinal symptoms are accompanied by systemic dis- 
turbance — paleness of the face, coldness of the surface (sometimes pre- 
ceded by a very temporary rise of temperature), irregularity and fee- 
bleness of the pulse, and great nervous and muscular prostration. 
When the quantity is sufficient to cause lethal symptoms, they are as 
follows : epigastric pain, vomiting and purging, shrunken features, 
cold breath, cyanosis, arrest of the urinary secretion, aphonia, cramps 
— the assemblage of symptoms belonging to the collapse of cholera. 

Tartar-emetic, w T hen used in considerable medicinal doses, sets up 
an irritation of the fauces followed by aphthous ulcerations, which con- 
tinue along the oesophagus to the stomach, and are accompanied by 
salivation and painful deglutition. 

Applied to the skin by friction, tartar-emetic excites a follicular 
inflammation, succeeded by a papule, a vesico-pustule, a surrounding 
inflammation with indurated base, a central umbilication, and finally 
desiccation, terminating in a brownish scab. These antimony-pustules 
are very similar to those of vaccine or variola. 

When applied to the skin or injected into the veins, tartar-emetic 
is absorbed, and manifests a selective action on the gastro-intestinal 



ANTIMONY. 285 

mucous membrane, causing the same irritant effects as are produced 
by its stomach administration. It is, therefore, a specific, and not a 
merely irritant emetic. 

Tartar-emetic readily diffuses into the blood. In what form, unless 
as an albuminate, it exists in the blood, is not understood. It dimin- 
ishes the number and force of the arterial pulsations, and rapidly low- 
ers the blood-pressure. The pulse may fall from 72 to 40, but, accord- 
ing to Hirtz, rarely is the number reduced more than 6 to 10 per min- 
ute. In the healthy subject, the normal temperature, even when a 
full medicinal dose has been administered, remains unaffected as to 
the trunk, but it may be reduced in the extremities. In fevers and 
inflammations, a considerable reduction of temperature may take 
place, and the same result has been noted in the physiological state 
when the quantity of tartar-emetic has been sufficient to produce 
choleriform symptoms. 

In man delirium, and in animals paralysis, motor and sensory, but 
without impairment of muscular contractility, have been observed from 
lethal doses of tartar-emetic. 

Tartar-emetic promotes waste and hastens the elimination of the 
products of waste — the excretion both of carbonic acid and of urea 
being greatly increased by it. 

The antimonial salts are found in the blood, in the liver, and other 
viscera, and are excreted by the bile, the milk, the perspiration, and 
the urine. It is, doubtless, also largely excreted by the intestinal 
glandular apparatus, as is the case with the metals generally. 

If tartar-emetic is administered in small doses, and the quantity be 
gradually increased, the nauseating effects of the drug may be en- 
tirely prevented. When emetic doses even are continued in some 
subjects, this effect finally ceases, and the drug is borne without pro- 
ducing any gastric symptoms. To this state has been applied the 
term tolerance, by the contra-stimulant school of practitioners. It 
must not be lost sight of, that this tolerance, on the part of the stom- 
ach, of large doses does not mean an indifference to the action of the 
remedy, but very serious and profound anatomical alterations may 
result. 

Therapy. — Tartar-emetic was, formerly, much more frequently 
prescribed than at present as an emetic in cases of indigestion charac- 
terized by a coated tongue, loaded stomach, and anorexia {Vembarras 
gastrioue). It is sometimes used as an emetic in cases of narcotic poi- 
soning, but sulphate of zinc is preferable. It was formerly used as 
an emetic in the first stage of typhoid and other fevers, but, notwith- 
standing this practice is frequently followed by good results, it is now 
rarely pursued. If emesis is desirable in these cases, a less irritating 
and depressing emetic should be used. 

In croup tartar-emetic is an efficient emetic, but it must be used 



286 AGENTS INCREASING WASTE. 

with caution, owing to the great depression which it produces, and the 
fatal result which has occurred in many instances. It is not a suitable 
remedy for infants and very young children. The compound sirup of 
squills is a domestic remedy for croup, but the incautious use of this 
has proved fatal. Tartar-emetic is used in laryngismus stridulus to 
produce emesis and consequent relaxation of the muscles of the larynx, 
and in true croup to cause the expulsion of the false membrane. The 
yellow subsulphate of mercury is safer and quite as effective. 

Tartar-emetic is an excellent remedy in the first stage of acute ca- 
tarrh, nasal, pharyngeal, and bronchial. It is most efficient in the 
first stage, when the mucous membrane is dry and swollen. It pro- 
motes secretion, diminishes fever, induces diaphoresis, and hastens the 
elimination of inflammatory products. In these cases, from one 
twentieth to one twelfth of a grain is usually a sufficient quantity, for 
it is not necessary that nausea be excited. When cough is violent, a 
little opium may be added to the prescription. $ Antimonii et po- 
tassii tart., gr. ss ; morphinae acetat., gr. ss ; aquae, § ij. M. Sig. : A 
teaspoonful every hour or two. In acute bronchitis, when the cough is 
dry and hoarse, this agent is useful, and small doses (one sixteenth of 
a grain), frequently repeated, are more serviceable than large doses 
at longer intervals. 

Formerly, under the influence of the contra-stimulant school, tartar- 
emetic was given in large doses in pneumonia. It was sought to es- 
tablish tolerance at an early period, and to administer the largest doses 
which could be borne. The comparative results of this method of 
treatment and of the expectant and restorative plans demonstrate the 
impropriety of the tartar-emetic treatment, and it is now abandoned. 
It is true that small doses of tartar-emetic, by increasing the action of 
the skin, kidneys, and intestinal canal, may exert a favorable influence 
over the temperature and diminish the plasticity of the exudation ; but 
even small doses must be employed with care, lest a depression should 
be induced which may interfere seriously in the natural course of a 
disease which is self -limited and has its period of crisis. 

Tartar-emetic gives great relief in spasmodic asthma when the bron- 
chial secretion is deficient, and in those cases brought on by an over- 
loaded stomach. In the former case small doses frequently repeated 
until very slight nausea is produced, and in the latter emetic doses, are 
necessary. The following is a useful form of expectorant in the acute 
inflammatory affections of the air-passages : 3 Antimonii et potassii 
tart., gr. j ; ammonii muriat., 3iv; ext. glycyrrhizae, 3j ; morphinae 
muriat., gr. j ; syrup, tolutan., aquae lauro-cerasi, aa 3 j. M. Sig. : 
A teaspoonful every two, three, or four hours. 

The ointment of tartar-emetic was formerly much employed to pro- 
duce pustulation of the chest in the more chronic pulmoriary diseases. 
This painful and disfiguring form of counter-irritation has passed out 



CADMIUM. 287 

of use. To produce a crop of variolus-like pustules on the skin does 
not cause a morbid process like caseous pneumonia or tuberculosis to 
cease its ravages ; on the contrary, such extensive suppuration in the 
skin rather favors the development of these diseases. 

A combination of tartar-emetic and opium is a serviceable hypnotic 
in some cerebral disorders. These remedies appear to be most useful 
when wakefulness and delirium are due to cerebral congestion, and 
in those subjects who become excited and wakeful from the use of 
opium alone. In the active delirium and wakefulness of typhoid fever, 
tartar-emetic and opium are prescribed : 1^ Antimonii et potassii tart., 
gr. j — grs. ij ; morphinse sulph., gr. jss ; aquae lauro-cerasi, J j. M. 
Sig. : A teaspoonful every two, three, or four hours. In delirium tre- 
mens, when the same conditions exist, the same combination may be 
prescribed. Since the introduction of chloral and bromide of potas- 
sium, however, the use of these drugs for the purposes just indicated 
has been much restricted. 

In acute inflammatory and febrile diseases, minute doses of tar- 
tar-emetic (gr. -^q), frequently repeated, render an incontestable ser- 
vice. Typhoid, typho-malarial, and remittent fevers, acute rheumatism, 
erysipelas, etc., are maladies thus benefited. This remedy is, of course, 
contraindicated when there is much irritability of the stomach and 
intestinal canal. At the outset of fevers it was formerly the custom 
to prescribe an active emetic, and good results certainly followed this 
practice. The author believes that he has frequently seen impending 
attacks of malarial fever aborted by emetic doses of antimony and 
ipecac. Free emeto-catharsis moderates the severity of remittent fever 
in robust subjects when produced in the incipiency of this disease, and 
also puts the mucous membrane in a better state for the disposition of 
medicines and food. 

Before the days of anaesthesia tartar-emetic was much used to relax 
the muscidar system for the reduction of dislocations, to facilitate the 
taxis in strangulated hernia, to relax rigid os and perineum in labor, 
etc., but it is now no longer employed for these purposes. 

Authorities referred to : 

Gubler, Dr. A. Commentaires Therapeutiques du Codex Medicamcntarius, p. 624, et seq. 

Hermann, Dr. L. Lehrbuch der experimentellen Toxicologic, p. 218, Antimonsalze. 

Nothnagel, Dr. Hermann. Handbuch der Arzneimittellehre, p. 218, et seq., Antimon- 
Fraparate. 

Radziejewsky, Dr. S. Schmidt's Jalirbucher der gesammten Median, vol. cliii, p. 10, 
Zur Wirkung des Aniimon. 

Taylor, Dr. A. S. On Poisons, American edition, p. 476. 

Trotjsseau et^ Pldoux. Traite de Therapeutique et de Matiere Medicate, edition by 
Paul, huitieme edition, vol. ii, p. 951. 

Cadmium. — Cadmium. Cadmium, Fr. ; Kadmium, Ger. (Not 
official.) C admit Sulp>has. — Sulphate of cadmium. 



288 AGENTS INCREASING WASTE. 

Action and Uses. — There is a strong resemblance— an identity 
of action, indeed — between zinc and cadmium, except that the latter 
is the stronger. Cadmium has a decidedly caustic and astringent 
taste ; it is powerfully nauseant and emetic, producing great depres- 
sion of the powers of life. Locally the effects are those of an irritant 
poison, and the systemic effects correspond ; although there are pro- 
duced such cerebro-spinal symptoms as coma and convulsions. This 
agent is not administered internally, the preparations of zinc being 
preferred for all purposes to which cadmium might be applied as a 
remedy. 

In ophthalmic practice, cadmium seems to be much esteemed as a 
colly Hum. It is held to possess special powers in causing absorption 
of opacities of the cornea : $ Cadmii sulph., grs. ij ; aquae rosoe, § j. 
M. Sig. : Colly Hum. A solution of the same strength is said to be 
an excellent local application in otorrhcea. There is no doubt that 
cadmium is an efficient injection in gonorrhoea ; but it is important in 
the application of this, as of so many other astringent remedies, that 
it be not too strong — one grain of cadmium sulphate to four ounces of 
water being sufficient in most cases. 

An ointment of cadmium is used somewhat by French physicians, 
in the treatment of external affections. For this purpose we may di- 
rect ten grains of the sulphate to be intimately incorporated with an 
ounce of simple ointment. 

Cerium. — Cerii Oxalas. — Oxalate of cerium. A white powder, in- 
soluble in water, alcohol, and ether. Dose, two to five grains in pill- 
form, as it is insoluble in the ordinary menstrua. It may be suspended 
in mucilage. 

Sir James Simpson was the first to propose the use of oxalate of 
cerium to restrain vomiting arising from various causes, especially 
from pregnancy ; and he brought forward many cases illustrative of 
its value. As he pointed out, it sometimes succeeds immediately, but 
usually the best effects are experienced after several days' use. The 
oxalate of cerium sometimes succeeds remarkably in vomiting due to 
serious organic lesions, as in cancer (Peters). It has been narrated 
in one case, that four grains were administered every two hours until 
about 600 grains were taken. The good result which followed this 
large administration of the drug indicates that, in vomiting from simi- 
lar causes, larger doses may be sometimes necessary to secure the best 
curative effects. In chronic diarrhoea, cerium may take the place of 
bismuth. 

In cases of cough associated with vomiting, excellent results have 
been obtained from the oxalate of cerium. It is probable that the 
cough is reflex in origin, the point of irritation existing in the terminal 
filaments of the pneumogastric in the gastric mucous membrane. 



METALLOTHERAPY. 289 

Met allot her apy. — Definition and Historical Development. — By the 
term metallotherapy is meant a curative method in which metals are 
applied to the affected area. 

The alchemists entertained extravagant notions of the therapeu- 
tical results to be achieved by the application of metals to the surface 
of the body. The influence of the noble metals over the bodily func- 
tions has been believed in from the remotest times within the histori- 
cal period, and this belief has been acted on by many influential per- 
sons down to nearly our own era. The action of magnetic iron 
contributed to this mystical notion. Then came the wonder-work- 
ing Mesmer. To the action of magnets was added that mysterious 
force evoked by the agencies employed by the Mesmerists. From 
such elements a pretended system of cure was elaborated, and a great 
many charlatans throve on the profits of this " system " of practice. 
Probably the most sustained success in this department of popular 
fallacies was effected by Dr. Perkins, of Connecticut, who invented a 
combination of metals arranged in the form of a cylinder, about six 
inches in length and two inches in circumference, which he called a 
tractor. Provided with a suitable handle, the tractor was slowly passed 
over the affected area, and the morbid process was drawn out or dis- 
persed. Perkins's tractors excited great interest in this country, and 
in England an immense enthusiasm. An institution — known as the 
Perkinian Institute — was established in London, and many of the no- 
bility and gentry resorted to it to be cured by the application of the 
tractors. In a book published by the son, there may be found many 
certificates of cures thus effected. These results are the less surprising 
when interpreted by the aid of subsequent developments from metal- 
lotherapy. Mesmer, Perkins, Hahnemann, appeared nearly simultane- 
ously, and each had an influence on the thought of the time. 

Metallotherapy, as now understood, had its origin in the experi- 
ments of Dr. Burq, which were first announced in a note addressed to 
the Academy of Sciences, and subsequently embodied in his thesis for 
the medical doctorate in 1851. He stated that a plate of metal — a sil- 
ver coin, for example — applied to the skin, may remove the paralyses 
of motility or of sensibility occurring in hysteria ; that the same metal 
was not equally successful in all cases, and that idiosyncrasies exist, so 
that in respect to each individual there is a special metal, active and cu- 
rative. In one subject it may be gold, in another silver, and in a third 
copper, which has the power to restore the lost motility or sensibility. 
Burq also maintained that the same metal taken internally, whether in 
the form of a natural mineral water or in a pharmaceutical preparation, 
produced the same result. In other words, when a piece of metal, a 
coin, selected according to the special sensibility of the subject, is ap- 
plied to an hysterical patient having permanent hemianesthesia, the 
return of the normal sensibility is effected in from ten to twenty minutes 
19 



290 AGENTS INCREASING WASTE. 

through a space of some extent, above and below the point of appli- 
cation. Numbness, tingling, and other disorders of sensation, dyses- 
thesia, etc., precede the return of sensibility to the anaesthetic area. 
The restoration of the sensibility proceeds from the point of applica- 
tion of the metal, and enlarges in all directions until the whole side 
returns to the normal. At the same time, an elevation of the temper- 
ature recognizable by the thermometer, and an increase of motor power 
as shown by the dynamometer, take place. These changes in the state 
of the sensory nerves are coincident with dilatation of the capillaries. 
The special senses undergo the same modifications. Sight, hearing, 
taste, and smell, are also in the condition of anaesthesia, and as the 
general sensibility is restored, these special organs return to their nor- 
mal state. 

Such, in brief, were the facts announced by M. Burq. A commis- 
sion, with M. Charcot at its head, was appointed to investigate the 
phenomena of metallotherapy. Hitherto the statements in regard to 
the effects of metals had been received with positive incredulity ; but 
the commission not only confirmed the accuracy of Burq's observations, 
but added some new facts. The first discovery made by them was the 
phenomenon of " transfer." By this term is meant a transference of 
functional powers. When the sensibility, the temperature, and the 
muscular power are restored to the side which had been anaesthetic, the 
other or normal side loses a part of its general and special sensibility. 
The commission also ascertained that when metals are applied for the 
relief of hemianaesthesia due to old organic lesions of the nervous cen- 
ters (such, for example, as cerebral hemiplegia), sensibility is restored 
also, but in a more durable manner. Thus, in a case of anaesthesia of 
ten years' duration, produced by a cerebral lesion, this symptom yielded 
to the application of gold. Other instances of the same character, and 
equally significant, were reported by the commission. These facts led 
Charcot to entertain the supposition that the effects produced by the 
application of the metals are really due to electrical action. It was 
ascertained, indeed, that electrical currents measurable by the galva- 
nometer are caused by the contact of the metals, and, conversely, that 
electrical currents of corresponding strength induced the same results 
as the metals, including the phenomena of transfer. The intensity of 
the current varies with the metal. In the case of a patient impression- 
able to gold, a current of two to twelve degrees suffices to restore the 
sensibility and the muscular force, while in one sensitive to copper, a 
current of forty to fifty degrees is required to effect the same result 
(Petit). 

As was above stated, when the metal to which the subject is found 
to be sensitive when applied locally, is given by the stomach, the same 
result is reached — that is, the anaesthesia is replaced by normal sensi- 
bility, the temperature rises to the natural level, and the muscular 



METALLOTHERAPY. 291 

power is restored. The commission discovered the remarkable fact 
that if, after the normal is thus resumed, the metal is again applied, the 
original anaesthesia comes on. To this return anaesthesia Charcot has 
applied the term metallic ancesthesia. A feeble electric current applied 
under the same conditions produces, also, a return anaesthesia, which 
is called postelectric. When the metallic plates applied to the skin are 
composed of metals superimposed, the same results as those obtained 
by a single metal are not produced. Thus, if in a patient sensible to 
gold a piece of silver is laid on the gold, the effects proper to the latter 
do not follow. The results due to the application of gold may be ren- 
dered durable in some cases by superimposing a piece of silver. If, 
after the effects produced by the application of a metal to which the 
patient is sensitive, another metal is placed above the first, the results 
due to the former may be fixed or rendered permanent. 

Notwithstanding the incredulity with which these observations on 
the action of metals were at first received, they have come to be gen- 
erally accepted. Prof. "Westphal, after a study of metallotherapy at 
Paris, made some investigations at Berlin, which, on the whole, were 
confirmatory. Charcot's observations were also sustained by the ex- 
periences of Thompson, Horrocks, and Wilks. An important contri- 
bution to the subject was made by Dr. Hughes Bennett, when he found 
that other substances besides metals caused the same results. In this 
experience we have an illustration of the old and well-known fact that 
discoveries are being constantly reproduced. When the Perkins ex^ 
citement was at its acme, Dr. Haygarth, of Bath, announced that 
wooden cylinders made in imitation of the genuine tractors had the 
same curative effects. It is clear, however, as M. Yigouroux has well 
said, that not all substances have the same action. This fact has also 
been demonstrated by Dr. Hack Tuke, who, having caused the anaes- 
thesia to disappear by the action of a metal, substituted a piece of car- 
bon of similar size and appearance, but the effect did not follow. 

Actions and Applications. — Charcot, as has been stated, supposed 
that the effects produced by the application of metals were due to elec- 
trical action. This theory does not suffice to explain all of the effects. 
By Dr. Tuke, " expectant attention " was invoked to explain the phe- 
nomena, but this theory is not tenable. Yigouroux holds that the dif- 
ference in electrical tension of some point of the organism is the real 
explanation of the phenomena resulting from the application of metals 
to the surface. 

According to Burq, the order of susceptibility to the impression 
of metals is as follows, each individual, as a rule, being susceptible to 
one metal only : iron, copper, gold, silver, tin, platinum (only rarely). 
These metals are applied in the form of disks, or large coins, and some- 
times disks of wood coated with the metals. Some other substances, 
as mentioned above, have exhibited the same phenomena, but the met- 



292 AGENTS INCREASING WASTE. 

als are unquestionably the most important. The metallic disks or 
coins are placed as a bracelet around the limb to be acted on, or 
individual disks are held in position by a bandage. The effects fol- 
low in a few minutes. The skin, previously pallid, cold, and without 
sensibility, becomes flushed, warm, and acutely sensitive, and in a 
short time the special senses are restored to their normal functional 
activity. As has been described, corresponding losses occur on the 
other side. 

Metallotherapy has been employed chiefly for the restoration of 
sensibility in cases of the hemianesthesia of hysteria, of paralysis of 
sensibility, in some instances of hemiplegia, and of certain functional 
paralyses of motility. It is not possible to formulate a set of rules for 
distinguishing the cases which will be benefited by these applications. 
Sometimes remarkable results are reached in a few applications ; then, 
again, unaccountable failures occur. 

Cases of writer's cramp, and of chorea, among the spasmodic af- 
fections, and neuralgia, have been suddenly cured by the use of the 
esthesiogenic metal ; but failures are greatly more frequent than the 
successes. When the metal to which the patient is sensitive has been 
ascertained, the further treatment may be conducted by the internal 
use of the same. 

Authorities referred to : 

[The literature of this subject is now so extensive, that its enumeration would occupy 
space entirely out of proportion to its utility here. A few of the more important contri- 
butions are given.] 

Burq, M. TAsse de Paris, quoted in Bull. Gen. de Therap., vol. xcvii, p. 33. 

Perkins, Benjamin Douglas, M. A., son of Dr. Perkins the discoverer. The Effi- 
cacy of Perkins's Patent Metallic Tractors in Topical Diseases, etc., London, 1800. 

Petit, Dr. L. H. Sur la Metallotherapie. Bull. Gen. de Therap., vols, xcvii, xcviii. A 
series of papers. 

Tuke, Dr. Hack. Metalloscopy and Expectant Attention. Journal of Mental Science, 
January, 1879, p. 598. 

Vigouroux, Dr. Le Pr ogres Medical, December 7, 1878, p. 944. 

Westphal, Prof. Dr. Berliner Minische Wochenschrift, July 29, 1878. 

Alumen. — Alum. Alun, Fr. ; Alaun, Ger. 

Ahtminis et Potassii Sulphas. — Potassa alum. A white, slightly- 
efflorescent salt, crystallizing in regular octahedrons, and possessing 
an acid, sweetish, astringent taste. It dissolves in from fourteen to 
fifteen times its weight of cold, and three fourths of its weight of boil- 
ing water, but is insoluble in alcohol. 

Alumen JExsiccatum. — Dried alum. Alum deprived of its water of 
crystallization by heat. A white, granular powder, odorless, but hav- 
ing a sweetish, astringent taste. Slowly but completely soluble in 
twenty parts of water at 60° Fahr. 

Aluminis Sulphas. — Sulphate of aluminum. Has a sour, somewhat 



ALUM. 293 

sweetish, and astringent taste, and an acid reaction. It is soluble in 
twice its weight of water. 

Antagonists and Incompatibles. — Alkalies and their carbonates 
and acetate of lead are chemically inconrpatible. 

Synergists. — The mineral and vegetable astringents promote its 
therapeutical activity. 

Physiological Actions. — The sweetish taste of alum first experi- 
enced is quickly followed by a decided astringency. It provokes an 
abundant flow of saliva, and the albumen of the saliva and buccal 
mucus is coagulated in whitish, membrane-like flakes. Contraction of 
the capillaries, blanching of the mucous membrane, and subsequent 
diminution of secretion, take place ; hence the dryness of the throat, 
thirst, and constipation, which result from its use. In doses of a tea- 
spoonful, or more, alum is an efficient emetic. Under certain morbid 
states it also proves laxative. Notwithstanding its power to coagulate 
albumen, it is absorbed into the blood, as was shown by Orfila, and 
may be found in the liver and in the urine. Circulating in the blood, 
alum affects the capillaries, diminishing their caliber, lessens secretion, 
especially of the mucous membranes, and arrests haemorrhage. In very 
large doses alum produces decided irritant effects — nausea, vomiting, 
abdominal pain, diarrhoea, etc. 

Dried alum, in consequence of its strong affinity for water, and its 
power to coagulate albumen, is a mild escharotic. 

Theeapy. — Alum is one of the remedies which may be used in 
gastric catarrh. It is said to be most effective when there is vomiting 
of glairy mucus. Pjg Aluminis, 3 ij ; extract, gentian., 3 ss. M. Ft. 
pil. no. xxx. Sig. : Two pills three times a day. Alum is a service- 
able haemostatic in hcematemesis. It is, of course, adapted only to 
cases of passive haemorrhage, when there is a relaxed condition of 
the mucous membrane. Other astringents — as, for example, Monsel's 
salt — are more effective. When intestinal haemorrhage is dependent 
on mechanical causes (cirrhosis, for example), and the mucous mem- 
brane is free from acute inflammation, alum is a serviceable astringent. 
It was formerly much used in chronic diarrhoea and chronic dysentery, 
but more effective agents are now employed in these diseases. The 
following formulae are applicable to the above-mentioned diseases, in 
the absence of more suitable agents : I> Aluminis, 3 ij ; pulv. aromat., 
3 j ; pulv. opii, grs. vj — grs. xij. M. Ft. pulv. no. vj. Sig. : One pow- 
der in honey or sirup three times a day or oftener. tjk Aluminis, 3 j ; 
extract, opii, grs. x ; catechu, 3 j. M. Ft. pil. no. xx. Sig.: Two pills 
every two, three, or four hours, fy Aluminis, 3 ij ; pulv. opii, grs. iij 
— grs. vj ; pulv. kino, 3] ; sacch. lactis, 3 j. M. Ft. pulv. no. vj. Sig.: 
One poicder every three hours. 

It is a singular fact that the most effective agent for the cure of 
colica pictonum is alum. It relieves the pain and nausea, and over- 



294: AGENTS INCREASING WASTE. 

comes the constipation, more certainly than any other agent. The 
chemical theory of its action is entirely unequal to the explanation of 
its remarkable effects ; the conversion of any portion of the lead pres- 
ent in the intestinal canal into the insoluble sulphate would not suffice 
to quiet pain, relieve flatulence, and relax the obstinately constipated 
bowels. Its action is doubtless dynamical : it overcomes the relaxa- 
tion and paresis of the muscular layer, on which the phenomena of 
lead-colic depend. The following are convenient formulae for the ad- 
ministration of alum in this disease : I£ Aluminis, 3 ij ; acid, sulphuric, 
dil., 3 j ; syrup, liraonis, § j ; aquae, § iij. M. Sig. : A tablespoonful 
every hour or two. r^ Aluminis, 3 ij ; vini, § iv ; catechu, 3 j ; traga- 
canthse, 3 j ; aquae, § viij. M. Sig. : A tablespoonful every hour. 
Alum- whey, prepared as follows, may be used in lead-colic : To a pint 
of boiling milk, add ninety grains of alum-powder ; separate the curd, 
and sweeten the whey if desired with an ounce of white sugar. A 
wineglassf ul may be taken every hour or two. 

Alum not unfrequently affords relief in gastralgia, enteralgia, and 
catarrh of the intestines. It is a serviceable laxative in females of lax 
fiber, in whom constipation depends upon a paretic state of the muscu- 
lar layer of the bowel. It is true that we possess many other agents 
more agreeable for administration, and also more effective ; but alum 
is cheap, and always to be obtained. 

Alum, dissolved in infusion or solution of the extract of logwood, 
is a useful injection in haemorrhage from the rectum, or as an applica- 
tion to bleeding piles, or as an astringent wash in prolapsus of the rec- 
tum in children. A crystal of alum, cut into a globular shape, may 
be passed into the rectum in such cases. The following ointment may 
be applied to haemorrhoids when they protrude, bleed, and are painful : 
^ Pulv. aluminis, 3 ij ; pulv. camphorae, pulv. opii, aa 3 j ; unguent., 
|j. M. Sig.: Ointment. 

Notwithstanding the theoretical objections which have been made 
as to its utility, the use of alum is sanctioned by high authority in 
haemorrhages from distant organs of the body. Oppolzer recom- 
mends the following formula : 1} Aluminis, amyli, aa 3 j ; sacchari, 
3 ij. M. Ft. pulv. no. vj. Sig. : One powder every two hours. Skoda 
advises the following formula in hmmoptysis : 1$ Aluminis, 3 j ; sacch. 
alb., 3 ss ; pulv. ipecac, comp., 3j. M. Ft. pulv. no. vj. Sig.: One 
powder every two hours. 

Alum was formerly used in diabetes mellitus, but more effective 
methods of treatment have taken its place. Good results have cer- 
tainly been produced by the use of alum in diabetes insipidus. Colli- 
quative siceats are moderated by the internal use of alum, and by 
sponging the surface with a solution. 

Alum has been used with a certain measure of success in whoop- 
ing-cough, during the spasmodic stage, but the more certain and pal- 



ALUM. 295 

atable remedies now in our possession have quite displaced it. As an 
emetic in croup, there is no doubt of the utility of alum. It is used 
to cause the dislodgment of the false membrane, and to prevent its 
re-formation. It acts without depressing the bodily functions, is 
prompt and thorough. A teaspoonful of the powder, mixed with 
honey or sirup, may be given, and repeated every half -hour until free 
emesis occurs. 

External Uses of Alum. — A solution of alum in nitric ether is 
said to be an effective application in toothache ( 3 ij — 3 vij). When 
the gums are spongy and ill-conditioned, and manifest a tendency to 
recede from the teeth, the following local application is very service- 
able : 5, Aluminis, 3 j ; vini, Oj ; tinct. cinchonae, J ss ; tinct. myrrhae, 
3 ij ; mel. rosae, f ij. M. Sig. : As a mouth-wash. When there 
is much relaxation of the faucial mucous membrane, alum and sugar, 
in equal proportions, may be applied by an insufflation-tube. Pow- 
dered alum, dusted over the affected surface, is a useful application 
in chronic pharyngitis, chronic tonsillitis, chronic nasal catarrh. Ul- 
cers of the mouth, whether syphilitic, or due to nursing, or arising 
from gastric disorder, are improved in character by application of a 
crystal of alum. A useful gargle in various affections of the mouth 
and throat is the following : ^ Infus. lini, § xv j tinct. kino, § j ; 
aluminis, 3 ij. M. Sig. : As a gargle. 

In catarrhal ophthalmia, after the acute symptoms have subsided, 
an alum-lotion is useful : r> Aluminis, 3 j ; aquae rosae, 3 iv. M. 
Sig. : Lotion. Alum-curd is a domestic application which is often ser- 
viceable : 3 ss of alum to the white of an egg. 

The following is a useful injection in chronic gonorrhoea : I£ Alu- 
minis, 3 j ; zinci sulphatis, 3 ss ; sodii biborat., grs. iv ; aquae rosae, 
§ viij. M. Sig. : An injection. This prescription is equally applica- 
ble to leucorrhcea. 

Alum is a useful haemostatic, but there are others more powerful. 
Alum is a constituent of the once famous Pagliari's mixture (Men- 
tel's) : ]J Benzoini, gr. c ; alcohol, fort., 3 ss. Dissolve and add 
water, § x ; alum, § j. The mixture is to be boiled until clear, and, 
when cool, filtered. This is also a good preservative solution for 
anatomical preparations, and is an effective application in leucorrhoea, 
pruritus of the vulva, etc. 

Alum 1 ss, the whites of four eggs, and tincture of camphor f ij, is 
an excellent application to bed-sores. Burned alum is a mild escha- 
rotic, which is sometimes used to destroy exuberant granulations. 

Authorities referred to : 

Gubler, Dr. A. Commeniaires de Thh'apeutique, etc., p. 433. 
Nothnagel, Dr. Hermann. Handhtch der Arzneimittellehre, p. 311. 
Trousseau et Pidoux. Traite de Therap., etc., vol. i, p. 188. 
Waldenburg und Simon. Handbuch der Arzneiverordnungs-Lehre, p. 154. 



296 AGENTS INCREASING WASTE. 

Acidum TannicUHL — Tannic acid. Tanin, Fr. ; Tanninum, Ger. 

Tannic acid has a yellowish- white color, and strongly astringent 
taste. It is soluble in 6 parts of water, in 0*6 part of alcohol, and 
in 6 parts of glycerin. Its solution reddens litmus, and produces, 
with solution of gelatin, a white, flocculent precipitate ; with the salts 
of the sesquioxide of iron a bluish-black precipitate ; and with solu- 
tions of the alkaloids white precipitates, very soluble in acetic acid. 
Dose, gr. j— 3j. 

Collodium Stypticum. — Styptic collodion. (Tannic acid, 20 parts ; 
alcohol, 5 parts ; stronger ether, 20 parts ; collodion, 55 parts.) 

Trochisci Acidi Tannici. — Troches of tannic acid. (Each troche 
contains one grain of tannic acid.) 

TTnguentum Acidi Tannici. — Ointment of tannic acid. (Tannin, 10 
parts ; benzoinated lard, 90 parts.) 

Suppositoria Acidi Tannici. — Suppositories of tannic acid. (Not 
official.) (Tannin, 3 j ; ol. theobromse, 3 v.) 

Acidum Gallicum. — Gallic acid. Acide gallique, Fr. ; Gallapfel- 
saure, Ger. 

Gallic acid is in small, silky, nearly colorless crystals, having a 
slightly acid and astringent taste. It is soluble in one hundred parts 
of cold, and in three of boiling water. The solution reddens litmus, 
and does not produce a precipitate with a solution of gelatin, or of 
sulphate of protoxide of iron. With solutions of salts of sesquioxide 
of iron, it produces a bluish-black precipitate, the color of which dis- 
appears when the liquid is heated. It is decomposed by a strong heat, 
and entirely dissipated when thrown on red-hot iron. Dose, gr. j — 
grs. x. 

TTnguentum Acidi Gallici. — Ointment of gallic acid. (Gallic acid, 
10 parts ; benzoinated lard, 90 parts.) 



The following remedies contain a tannic acid, and have physio- 
logical and therapeutical actions due to the presence of this sub- 
stance : 

Galla. — Nutgall. Nbix de galle, Fr. ; Gallapfel, Ger. 

Tinctura Gallce. — Tincture of galls. Dose, 3 ss — 3 ij. 

TTnguentum Gallce. — Ointment of galls. (Galls in fine powder, 10 
parts ; benzoinated lard, 90 parts. 

Composition. — Tannic acid (gallo-tannic), 60 to 70 per cent ; gallic 
acid, 3 per cent ; sugar, resin, etc. 

Catechu. — Catechu. An extract prepared principally from the 
wood of Acacia catechu. Cachou, Fr. ; Katechusafe, Ger. 



TANNIC ACID AND VEGETABLE ASTRINGENTS. 297 

Tinctura Catechu Composita. — Tincture of catechu. (Catechu, 12 
parts ; ciimamom., 8 parts ; diluted alcohol, a sufficient quantity to 
make 100 parts.) Dose, fi[ x — 3 j. 

Infusion Catechu Compositum. — Compound infusion of catechu. 
(Not official.) (Catechu, § ss ; cinnamon, 3j; boiling water, Oj.) 
Dose, 3 j — 1 ss.) 

Trochisci Catechu. — Troches of catechu. Each troche contains 
one grain of catechu. 

Composition. — Catechin, or catechuic acid. 

Kino. — Kino. The inspissated juice of Pterocarpus marsupium, 
and of other plants. Kino de VInde, Fr. ; Kino Gummi. Ger. 

Tinctura Kino. — Tincture of kino (10 parts to 100). Dose, ttj, x 

— 3 ij. 

Composition. — Kino-tannic acid. 

Krameria. — Rhatany. The root of Krameria triandra and of K. 
tomentosa. Matanhia, Fr. ; Jtata?ihiaiourzel, Ger. 

Extractum Kramerim. — Extract of rhatany. Dose, grs. v — grs. x. 
Tinctura Krameria}. — Tincture of rhatany (20 parts to 100). Dose, 

m v— 3 j. 

Extraction Kramerim Fluidum. — Fluid extract of rhatany. Dose, 
ni v — 3 ss. 

Composition. — Ratanhia-tannic acid ; odorous principle ; wax, 
gum, etc. 

Hsematoxylon. — Logwood. The heart-wood of llazmatoxylon Cam- 
pechianum. Bois de Campeche, Fr. ; Campecheholz, Ger. 

Decoctum JTcematoxyli. — Decoction of logwood. (Not official.) 
(Logwood, 3 j ; water, Oij, boiled down to Oj.) Dose, § ss — § j. 

Extractum JTcematoxyli. — Extract of logwood. Dose, gr. v — 3 j. 

Composition. — Hematoxylin, tannic acid, etc. 

Geranium. — Cranesbill. The rhizoma of Geranium maculatum. 

Extractum Geranii Fluidum. — Fluid extract of geranium. Dose, 
m v— 3 j. 

Composition. — Tannic and gallic acids, resin, gum, starch, chloro- 
phyll, etc. 

Quercus Alba. — White-oak bark. 

Quercus Tinctoria. — Black-oak bark. (Not official.) iScorce de 
chene, Fr. ; Eichenrinde, Ger. 

Decoctum Quercus Albm. — Decoction of white-oak. (Not official.) 
( 3 j — Oj.) Dose, I ss— f j. 

Composition. — Quercitrin or quercitric acid, tamiic acid, etc. 



298 AGENTS INCREASING WASTE. 

Rosa Gallica. — Red rose. The petals of Bosa Gallica. Hoses 
rouges, Fr. ; Essigrosen, Ger. 

Confectio Bosw. — Confection of rose. 

Extractumn Bosce Fluidum. — Fluid extract of rose. Dose, m v 
-3ij. 

Mel Bosce. — Honey of rose. 

Composition. — Tannic and gallic acids, quercitrin, coloring matter, 
volatile oil, etc. 

Rubus. — Blackberry-root. Bark of the root of Bubus Canadensis 
and Bubus villosus. 

Extractum Bubi Fluidum. — Fluid extract of rubus. Dose, ttj, x 
-3ij. 

Aromatic sirup of blackberry, which is not official, contains black- 
berry-root, cinnamon, cloves, and mace. A fluid ounce contains the 
strength of thirty grains of the root. 

Composition. — Tannic acid, etc. 

Myrica Cerif era— Bay berry, wax-myrtle. (Not official.) Bark of 
the stem and root. 

Decoction is made by boiling an ounce in a pint of water — dose, 
§ ss — | j. An alcoholic extract (myricine of the eclectics) — dose, 
grs. v ; and a fluid extract — dose, 3 ss — 3 ij — are to be obtained in the 
shops. 

Composition. — Tannic and gallic acids, myricinic acid, resin, red 
coloring matter, etc. 

The most important property is the astringency due to the large 
quantity of tannic and gallic acids. In large doses it is emetic. 

Statice Limonium. — Marsh rosemary. (Not official.) The root. 
A decoction ( § ] — Oj) may be used — dose, § ss — § j. A fluid extract 
is prepared — dose, t\[ xx — 3 j. 

Composition. — Tannic acid (twelve per cent), gum, extract, etc. 

Alnus Serrulata. — Common alder. (Not official.) The bark in de- 
coction ( 3 j — Oj) — dose, | ss — 1 j. Fluid extract — dose, tti x — 3 j. 
Alcoholic extract (alnuin of the eclectics) — dose, gr. j — grs. v. 

Composition. — Tannic acid, oil, resin, etc. 

Heuchera. — Alum-root. Root of Heuchera Americana. (Not offi- 
cial.) Decoction — dose, § ss — § j ; fluid extract — dose, ttl x — 3 j. 
Composition. — Tannic acid, etc. 

Hamamelis. — The leaves of Hamamelis Virginica. Witch-hazel. 
Extractum Hamamelidis Fluidum. — Fluid extract of hamamelis. 
Dose, ttl x — 3 ij. 

Composition. — Tannic acid, odorous matters, etc. 



TANNIC ACID AND VEGETABLE ASTRINGENTS. 299 

Nymphsea Odorata. — Sweet-scented water-lily. Root. Decoction 
( | j — Oj) — dose, 3 ss — 1 j. Fluid extract — dose, 3 ss — 3 j. (Not 
official.) 

Composition. — Tannic acid, gallic acid, etc. 

Castanea. — Leaves of Castanea vesea Linne (Nat. Ord. Cupuliferai), 
collected in September or October, while still green. (U. S. P.) 
Composition. — Tannic acid, etc. 

Antagonists and Incompatibles. — The mineral acids, the salts 
of antimony, lead, and silver, and the persalts of iron, and alkalies, 
are chemically incompatible. The vegetable alkaloids and gelatin 
form insoluble precipitates. 

Synergists. — Tonics and bitters, as a rule, favor the action of 
tannic and gallic acids, and of the substances containing them. The 
agents comprehended in this group — or remedies whose chief result is 
to increase waste — are synergistic. 

Physiological Actions. — Tannin has a bitter astringent taste, and 
constringes the mucous membrane. In the stomach it enters into com- 
bination with albumen, and with the pepsin of the gastric juice, which 
it precipitates from its solution. Tannin, therefore, impairs digestive 
power by rendering the pepsin inoperative. It diminishes secretion of 
the mucous membrane by virtue of its power to contract the caliber of 
the vessels, and it restrains peristalsis by its action on the muscular 
layer ; hence the constipating effects which follow its use. If long 
continued in considerable quantity, tannin disorders digestion, sets up 
irritation of the mucous membrane, and gives rise to a febrile state 
and to wasting of the tissues. 

Having such affinity for and coagulating action on albumen, it is 
obvious that tannin must diffuse into the blood with difficulty. A 
part undergoes conversion into gallic and pyrogallic acids in the 
stomach, and in this form is absorbed. Injected into the veins, tannic 
acid coagulates albumen, and the results which follow are due to mul- 
tiple embolisms. Elimination of tannin takes place by the intesti- 
nal canal and by the kidneys, in the form of gallic and pyrogallic 
acids. 

Therapy. — Catarrh of the stomach, a relaxed state of the mucous 
membrane, acidity, and flatulence, are conditions in which tannic acid 
is useful. It may be given in pill-form with sufficient glycerin to 
make a mass of proper consistence — one drop to four grains. Harnia- 
temesis dependent on ulcer of the stomach, or obstructive disease of 
the liver, and not inflammatory in origin, is an indication for tannin. 
It should be given in solution and in a large dose — grs. x — 3j. Tan- 
nic acid is an efficacious remedy in diarrhoea, after acute symptoms 
have subsided, in chronic diarrhoea, colliquative diarrhoea, the diarrhoea 



300 AGENTS INCREASING WASTE. 

of phthisis, etc. Notwithstanding the chemical incompatibility, com- 
bination with opium or morphine increases the efficacy of the tannin. 
As tannic acid, in large part, at least, escapes conversion into gallic, and 
passes unchanged into the intestine, its action is doubtless chiefly local. 
Oppolzer advises the following formula in profuse diarrhoea : fy Acidi 
tanuici, 3 ij ; pulv. opii, grs. vj ; sacchari, q. s. M. Ft. pulv. no. 
vj. Sig. : One every two hours. In cholera diarrhoea, A. von Graefe 
prescribed a solution of tannic acid in cinnamon-water and mucilage 
every half -hour. For the diarrhoea and intestinal haemorrhage of ty- 
phoid fever, tannin is one of the most serviceable remedies. Accord- 
ing to Stille, whose faith appears rather extravagant, there is no more 
effective remedy for chronic diarrhoea and chronic dysentery than tan- 
nic acid conjoined with a milk-diet. 

Various members of this group are used in the above-mentioned 
diseases. Kino has been a favorite remedy in pyrosis, and is also 
given in diarrhoea! diseases. Catechu, in the form of the tincture 
chiefly, is frequently added to prescriptions for diarrhoea, notably to 
chalk-mixture in the diarrhoea of children. Kino is a favorite remedy 
for the diarrhoea of phthisis, but it is not more efficacious, and is more 
disagreeable in administration, than tannic acid. Several of the in- 
digenous remedies mentioned above possess undoubted value in the 
treatment of diarrhceal diseases. A decoction of rubus or geranium, 
obtained by boiling the root in milk ( 3 j — Oj), is an excellent remedy 
in cholera infantum and the summer diarrhoea of children. When a 
nursing child passes rather frequent, greenish, and watery stools, and 
suffers with pain and colic at each motion, great relief will be afforded 
by the use of syrupus rubi, or better by the unofficial compound sirup 
of rubus. In the chronic diarrhoea of adults, and in acute diarrhoea 
after the subsidence of inflammatory symptoms, the fluid extracts of 
hamamelis, of heuchera, and of statice, may be used with advantage. 
In hcematemesis and intestinal haemorrhage the hamamelis is very ef- 
fective, owing, doubtless, to the very large percentage of tannin which 
it contains. 

The comparative merits of tannic and gallic acids may be f ormu- 
larized as follows : for local effects tannic acid, for systemic effects 
gallic acid is to be preferred. It is true that tannic acid affects re- 
mote parts, but in order to diffuse into the blood it must first be con- 
verted into gallic, and hence the systemic actions are really due to the 
latter. It follows that gallic acid should be prescribed when the as- 
tringent effects on the tissues elsewhere than the intestinal canal are 
to be produced. Gallic acid is an effective remedy for pulmonary and 
renal hemorrhage. For the former we possess other agents more ef- 
ficient, but for the latter it is more uniformly successful than any other 
remedy. The success of rhatany, which was formerly much used in 
hematuria, was doubtless due to its tannic and gallic acids. In the 



TANNIC ACID AND VEGETABLE ASTRINGENTS. 301 

hemorrhagic diathesis, gallic acid is one of the remedies which may 
be used with advantage. Although it can not be combined with chalyb- 
eates, it may be given alternately with them. "Whenever haemorrhage 
occurs in relaxed and debilitated constitutions — is passive in character 
— gallic acid may be combined with ergotine and digitalis : r> Acid, 
gallici, 3 i ; ergotine (aq. ex.), digitalis, aa 3j. M. Ft. pil. no. xx. 
Sig. : One every four hours. 

As gallic acid has the power to restrain secretion of mucous sur- 
faces, it may be prescribed, experience has shown with good effect, in 
chronic bronchial catarrh. When bronchiectasis exists, the good effects 
of the remedy are by no means conspicuous, but it is very serviceable 
when the bronchial catarrh is the result of the irritation extending 
from disease of the parenchyma of the lungs, or is produced by mitral 
or tricuspid regurgitation, or is the sequel of acute catarrh. In pyelitis 
and pyelo-nephritis, gallic acid and the remedies containing it diminish 
the purulent discharge, and retard changes in the mucous membrane. 
It is also a serviceable remedy in catarrh of the bladder. In these 
states, to insure as far as possible its rapid and complete diffusion into 
the blood, it should be given frequently and well diluted. As it is 
soluble in eight parts of rectified spirit, and as this solution mixes in 
all proportions with water without precipitation, a spirituous solution 
should be prescribed : $ Acidi gallici, 3 j ; spirit, vini rectif., \ j. M. 
Sig.: A teaspoonful in sufficient icater every four hours. 

Gallic acid has the power to restrain the waste of albumen in cases 
of albuminuria. It is adapted to the acute forms — desquamative ne- 
phritis, the albuminuria following scarlatina, etc., and does not seem, 
according to the author's observation, to check in the least the loss of 
albumen in the chronic forms of albuminuria. Dr. Aitken recommends 
the following formula : ^ Acidi gallici, 3 j — 3 ij ; acid, sulphuric, dil., 
3 ss ; tinct. lupuli, 3 j ; infus. lupuli, f vj. M. Sig.: A tablespoonful 
three times a day. 

The following mixture is very effective in menorrhagia, hematu- 
ria, purpura hemorrhagica, and the hemorrhagic diathesis : t^ Acidi 
gallici, 3 ss ; acid, sulphur, dil., 3 j ; tinct. opii deod., 3 j ; inf. rosae 
comp., 3 iv. M. Sig. : A tablespoonful every four hours or oftener. 

Hillier advises the following prescription for chronic diarrhea in a 
child of two years : r£ Acidi gallici, gr. xij ; tinct. cinnamomi comp., 
3 jss ; tincturae opii, m, viij ; aquae carui ad § ij. M. Sig.: Two tea- 
spoonfuls a dose. 

For the sweating of phthisis the following formula is useful : fy 
Acid, gallici, 3 ss ; ext. belladonnas, gr. ij. M. Ft. pil. no. x. Sig.: 
Two pUls at bed-hour. 

In addition to the foregoing internal applications of the vegetable 
astringents, it may be mentioned that a decoction of chestnut-leaves 
(castanea) has been used with much success in whooping-cough. As 



302 AGENTS INCREASING WASTE. 

both tannic and gallic acids have been employed with more or less 
service in this disorder, it is probable that the good effects of castanea 
are really due to the presence in it of these acids. The decoction of 
castanea may be drunk ad libitum, or the fluid extract may be admin- 
istered in drachm-doses. 

External Uses of Tannic Acid and Substances containing it. 
— Dr. B. W. Richardson has proposed a tannin solution, to which he 
has applied the term styptic colloid. It consists of a saturated solution 
of tannin in alcohol (one part to eight) mixed with collodion. This is 
an elegant application to restrain oozing of blood from a large surface, 
to unite incised wounds, to protect lacerated wounds, to remove fetor 
from decomposing animal matter, to change the character of foul 
idcers, etc. The following formula was proposed by Monsel as a 
haemostatic : ^ Acidi tannici, 3 j ; aluminis, 3 ij ; aquae rosa?, § iij. 
M. Sig. : For external use as a haemostatic. The glycerite of tannin 
is a neat formula for external application. 

Tannic acid is much employed as an application to the mouth and 
throat in various diseases of these parts. In mercurial salivation an 
excellent application is a solution of tannin, with honey of roses : IJ 
Acidi tannici, 3 j ; mel rosae, § ij ; aquae, § vj. M. Sig.: As a gargle. 
Elongated uvula, relaxed palate, and follicidar pharyngitis, are effec- 
tively treated by insufflation of tannin, i. e., some finely-powdered tan- 
nin blown over the affected surface with a hand-ball insufflator. Epis- 
taxis may often be promptly arrested by passing through the nares a 
strong solution of tannin ( 3 ij — 1 iv) by means of a post-nasal syringe 
or nasal douche, or powdered tannin may be blown on the bleeding 
surface by an insufflator. The following is an excellent gargle for the 
more chronic throat-affections : fy Acidi tannici, 3 ij ; spts. vini rect., 
3 j ; mist, camphor, ad § x. M. Sig. : An astringent gargle. In 
chronic affections of the larynx mucous membrane, and of the vocal 
cords, no inhalation is more frequently serviceable than a solution of 
tannin (grs. x — 3] — ? iv) applied by means of the hand-ball or 
steam atomizer. This treatment is useful in chronic catarrh of the 
fauces, of the larynx, trachea, and bronchi, in ulcerations of the 
pharynx, larynx, and trachea, in bronchiectasis, in pulmonary haemor- 
rhage, gangrene of the lung, oedema of the glottis, croup, and diph- 
theria. 

The following is Druitt's prescription for toothache : 3 Acidi tan- 
nici, 3j ; mastich, grs. x ; etheris, § ss. M. Sig. : To be applied on 
cotton to a carious tooth. 

Tannin solutions of various strengths (gr. j — grs. x — 3 j) are used 
in inflammation of the conjunctiva. Hairion advises a strong solution 
( 3 j — 3 iij) in acute and chronic conjunctivitis, gramdations, corneitis, 
chemosis, and pannus. Very remarkable results have been obtained 
by Dr. Hamilton, of Liverpool, in certain diseases of the eye by the 



TANNIC ACID AND VEGETABLE ASTRINGENTS. 303 

application of powdered tannin to the conjunctiva. This method con- 
sists in dusting over the everted lid finely-powdered tannic acid, using 
for this purpose a small rubber-bag insufflator. He employs this method 
with signal success in " granular ophthalmia, pannus, phlyctenular or 
pustular ophthalmia, chronic granulations, herpes corneas, fascicular 
corneitis, and some ulcers of the cornea." This application produces 
very little pain at the moment, and is not followed by any inflamma- 
tory reaction. 

Tannic acid has limited uses in diseases of the skin. It is an excel- 
lent application, especially in the form of the glycerite, in eczema, im- 
petigo, and intertrigo. The powder dusted on the affected surface is 
serviceable in cases of ulceration of the skin, and promotes the healing 
process in cases of old ulcers. One of the best applications to irritable 
and fissured nipples is glycerite of tannin. 

Chronic otorrhoea and the vulvitis of children are successfully 
treated by application of the glycerite of tannin. The same remedy 
is one of the best injections in gonorrhoea. Solutions of tannic acid of 
various degrees are used in gonorrhoea. Ricord recommends, in obsti- 
nate cases, after the subsidence of acute symptoms, 3 ss of tannic acid 
in | viij of claret wine. This constitutes a serviceable injection in leu- 
corrhoea. Sigmund advises the following in gonorrhoea : fy Acidi tan- 
nici, grs. ij — grs. x ; tinct. iodinii, m v ; aquae, § j. M. Sig. : As 
an injection. An infusion or decoction of galls, of oak-bark, of witch- 
hazel (hamamelis), of geranium, of alum-root, or other remedies of the 
list at the head of this article, may be advantageously used in cervicitis, 
vaginitis, purulent discharges from the vagina. In these affections 
the glycerite of tannin, and, much better, the powdered tannin, may 
be freely applied to the vaginal canal. The author knows of no more 
effective application in these maladies than tannin and iodoform, or iodo- 
tannin, applied in the dry way, well packed around the cervix uteri. 

A serviceable ointment for haemorrhoids is the following prescrip- 
tion of Oesterlen : I£ Pulv. gallse, 3 j ; pulv. opii, grs. x ; ung. plumbi 
subacetat., 3ij ; ung. simplicis, 3 j. M. Sig. : Ointment for haemor- 
rhoids. F 'or prolapsus ani in children the glycerite of tannin, pow- 
dered tannin, or a decoction of the vegetable astringents considered in 
this article, may be used, the mucous membrane being first carefully 
cleansed and then brushed over with the medicament. Ulcers of the 
rectum and anus, fissures of the anus, are very effectively treated by 
the direct application of the powder of tannin, tannin and iodoform, 
or iodo-tannin. The ulcer must be exposed, if necessary, by the use 
of the speculum, and then the powder be thoroughly applied to the 
affected surface. Trousseau strongly recommends a mixture of the 
decoction and the tincture of rhatany as an injection for the cure of 
fissure of the anus, but the applications above advised are neater and 
more effective. 



304 AGENTS INCREASING WASTE. 

Authorities referred to : 

Hamilton, Robert, F. R. C. S. On the Employment of Tannic Acid in some Diseases 
of the Eye and Eyelids. The Practitioner, vol. ii, p. 347. 

Hanbcry and Fluckiger. Pharmacographia, pp. 170, 213, 536, et seq. 

Huseman, Drs. August und Theodor. Die Pflanzenstoffe, p. 996, and pp. 1002, 1006, 
1008, et seq. 

Pharmacopeia of the Throat Hospital. 

Phillips, Dr. C. D. F. Materia Medica and Therapeutics, p. 520. 

Porcher, Dr. Francis Peyre. Resources of the Southern Fields and Forests : Yarious 
articles on the indigenous remedies mentioned at the head of this article. 

Ringer, Dr. Sidney. On the Glycerine of Tannin. The Practitioner, vol. i, p. 27. 
Ibid., Handbook of Therapeutics. 

Stille, Dr. Alfred. Treatise on Therapeutics and Materia Medica, fourth edition, 
vol. i, article Vegetable Astringents. 

Trousseau et Pidoux. Trait'e de Therap. et de Mat. Med., huitiemc edition, vol. i, 
p. 133, et seq., article Medicaments Astringents. 

Waldenburg und Simon. Handbuch der Arzneiverordnungs-Lehre. 

Waldenburg, Prof. Dr. L. Die locale JBehandlung der Krankheiien der Athmungs- 
organe, Berlin, 1S72, p. 237, et seq. 

Colchicum. — Meadow saffron. Colchique, Fr. ; Zeitlose, Ger. 

Colchici Radix. — Colchicum-root. The corm of Colchicum autum- 
nale. 

Colchici Semen. — Colchicum-seed. The seed of Colchicum autum- 
nale. 

Preparations. — 1. Of the root. 

Extractum Colchici Hadicis Fluiclum. — Fluid extract of colchicum- 
root. Dose, ni ij — ttj, v. 

Vinum Colchici Hadicis. — Wine of colchicum-root. Forty parts 
of colchicum-root to one hundred of stronger white wine. Dose, 
IT], v — th, xxx. 

Extractum Colchici Hadicis. — Acetous extract of colchicum-root. 
Dose, gr. ss — gr. ij. 

2. Of the seed. 

Extractum Colchici Seminis Fluidum. — Fluid extract of colchicum- 
seed. Dose, TTi ij — in, x. 

Tinctura Colchici. — Tincture of colchicum. Fifteen parts of 
colchicum-seeds to one hundred parts of diluted alcohol. Dose, 

mx— 3j. 

Vinum Colchici Seminis. — Wine of colchicum-seed. Fifteen parts 
of the seed to one hundred parts of stronger white wine. Dose, in, x 

-3j. 

Composition. — Tannic and gallic acids, starch, sugar, gum, a pe- 
culiar alkaloid, colchicine^ or colchicine. Colchicine is easily converted 
(by acids, in long-kept alcoholic preparations) into an isomeric, crys- 
tallizable body, colchicein. The amount of the alkaloid contained in 
the root and the seed is said to be not greater than the half of one per 
cent. Colchicine is not crystallizable, but combines with acids to form 






COLCHICUM. 305 

crystallizable salts. The conversion, in any of the pharmaceutical 
preparations, of colchicine into colchicein, does not appear to impair 
the therapeutical activity. That colchicine is the active principle, is 
proved by the fact that the physiological effects of this alkaloid are 
the same as those of the crude drug (Husemann). 

Antagonists and Incompatibles. — Tannic acid, by forming an 
insoluble tannate with the alkaloid, retards but does not prevent its 
absorption. When a lethal quantity has been taken, emetics and pur- 
gatives are required, and demulcents may be freely administered. 
Opium and the alcoholic substances antagonize the depression of the 
heart's action. 

Synergists. — Such alkaloids as produce gastro-intestinal irritation 
and depress the action of the heart, e. g., veratrine, aconitine, etc., are 
synergistic. Therapeutically considered, emetics, purgatives, alkalies, 
promote the activity of colchicum. 

Physiological Actions. — Colchicum imparts its virtues to water, 
alcohol, and ether. It has a bitter taste, and excites the flow of saliva. 
In small doses it increases the mucous and glandular secretion of the 
stomach and intestines, and probably also of the liver, kidneys, and 
skin. If the dose be large but still medicinal, colchicum produces a 
feeling of epigastric heat, nausea, and vomiting, depression of the cir- 
culation, muscular feebleness, headache. It frequently purges, pro- 
ducing copious watery stools, and is generally held to increase the 
discharge of biliary matters. It increases the flow of urine, of the 
solid constituents (urea, uric acid, etc.), as well as of the water, and 
promotes the cutaneous transpiration. In toxic doses colchicum pro- 
duces all of the local as well as the systemic effects of an irritant 
poison, viz. : acute abdominal pain, profuse watery and choleriform dis- 
charges, suppression of urine, feeble pulse, cold sweat, coldness of the 
extremities. The intellect remains unaffected until carbonic-acid poi- 
soning supervenes. The muscular cramps which have been occasionally 
observed are probably due to the great loss of fluid from the system. 
When colchicine is injected subcutaneously, gastro-intestinal inflamma- 
tion is produced, showing that it has a selective action on this tissue. 

Therapy. — Colchicum is indicated when rapid wasting of tissue 
and prompt elimination of the products of waste are required. Its use 
at the present time is almost entirely restricted to the treatment of 
gout in its various manifestations. It relieves the pain, diminishes the 
swelling, and shortens the duration of an attack of acute gout. In 
order to accomplish these results, it is not necessary that the more 
harsh and violent physiological effects of the drug be produced. Suf- 
ficient quantity of colchicum should be given to increase secretion from 
the skin, the intestinal mucous membrane, and the kidneys, but nausea 
and vomiting should be avoided. Combination with an alkali increases 
the therapeutical effect of colchicum : I> Spts. ammonias aromat., 3 xiij ; 
20 



306 AGENTS INCREASING WASTE. 

vini seminis colchici, 3 iij. M. Sig. : A teaspoonful every three hours, 
until some physiological effect is produced. The following is a formula 
used at the London Hospital for gout : fy Tinct. colchici seminis, ttj, xx ; 
potassii bicarbonat., grs. x ; aquae pimentae, | j. M. Sig. : A draught. 
The following modification of Scudamore's prescription is in use at 
University College Hospital : ^ Tinct. colchici seminis, Hi xv ; mag- 
nesii carb., gr. vj ; magnesii sulph., grs. xxx ; aquae menth. pip. ad 
| j. M. Sig. : A draught. After the more acute symptoms of the 
gouty attack have subsided, the following was recommended by Sir 
Henry Halford : ^ Ext. colchici acet., gr. vj ; pulv. opii et ipecac, comp., 
ext. colocynth. comp., aa gr. xij. M. Ft. pil. no. xij. Sig. : One pill 
night and morning. The efficiency of colchicum is increased by com- 
bination with digitalis : ^ Ext. colchici acet., gr. x ; pulv. digitalis, 
ext. colocynth. comp., aa 3 j. M. Ft. pil. no. xx. Sig. : One pill 
twice or thrice a day. 

The active principle, colchicine, is, there is reason to believe, more 
successful in gout than any of the preparations of the crude drug. I£ 
Colchicine, gr. j ; ext. colocynth. comp., 3 ss ; quininae sulph., 3 iij. 
M. Ft. pil. no. lx. Sig. : One every four hours. 

In the so-called rheumatic gout, colchicum with alkalies is extreme- 
ly serviceable. Attacks, without decided pain and inflammation, of 
soreness of joints, which have been the seat of gouty attacks, or about 
which nodosities have been deposited, are relieved by colchicum. 

Constipation, hepatic congestion, and headache, due to torpor of 
the portal circulation, occurring in gouty subjects, are quickly relieved 
by a combination of colchicum and saline purgatives. The plethoric 
and overfed without being gouty, suffering from the same group of 
symptoms, are relieved by the same means, Inflammations of internal 
organs occurring in gouty subjects, for example, gouty bronchitis and 
rheumatic pneumonia, are best treated with prescriptions containing 
a preparation of colchicum. The following prescription is recom- 
mended by Greenhow in gouty bronchitis : ^ Potassii iodidi, ammonii 
carbonat., aa 3j ; vin. colchici seminis, 3 j ; tinct. scillae, tinct. hyos- 
cyami, aa 3 ij ; aquae c amphorae q. s. ad § iij. M. Sig. : A table- 
spoonful three times a day. 

Although colchicum is still advocated by some authorities in acute 
rheumatism, the general professional experience is against its use. In 
chronic rheumatism, when the joint changes are allied in nature to 
those which take place in gout, it is unquestionably serviceable. Neu- 
ralgia occurring in gouty and rheumatic constitutions is often relieved 
by colchicum. The indications for its use are plethora, constipation, 
and deficient excretion of the liver, kidneys, and skin. Colchicum re- 
lieves in such cases, by setting up an eliminative process. In hepatic 
dropsy and cardiac dropsy, when the patient is vigorous, the gastro- 
intestinal tract free from inflammatory mischief, colchicum may be 



SARSAPARILLA. 307 

used with advantage as a hydragogue : 3 Elaterii, gr. j ; spts. etheris 
nitre-si, § ij ; tinct. scillae, tinct. colchici, aa § ss ; syrup, simplicis, § j. 
M. Sig. : A teaspoonful three or four times a day. The following 
combination is an excellent diuretic in dropsy : I£ Vini seminis col- 
chici, 1 ss ; sol. ammonii acetat., § ijss ; inf. petroselin, § v. M. Sig. : 
A tablespoonful every four hours. This prescription is well adapted 
to dropsy following scarlatina. 

Colchicum is a serviceable remedy in certain cerebral disorders. 
Thus, it may be used in acute cerebral congestion in plethoric subjects, 
in urmmic intoxication, in hypochondriasis, especially when due to 
deficient elimination (uric acid, oxalate of lime, etc.). 

The wine of colchicum-seed has frequently succeeded in curing 
gonorrhoea, and by Brodie a nightly dose of thirty minims was given 
for the relief of chordee. In the treatment of gonorrhoea, the follow- 
ing may be used : ££ Vini colchici seminis, § ss ; sol. potassii citratis, 
1 vjss ; tinct. opii deod., 3 ij. M. Sig. : A tablespoonful three or 
four times a day in gonorrhoea. 

Authorities referred to : 

Brodie, Sir Benjamin. Works by Mr. Hawkins, Diseases of Urinary Organs, 
vol. ii. 

Caspar, Johann Ludwio. Practisches Handbuch der gerichtlichen Medicin. Neu 
bearbeitet und vermehrt von Dr. Carl Liman, Berlin, 1871, p. 570. 

Fuller, Dr. William Henry. On Rheumatism, Rheumatic Gout, etc., 1874. 

Greenhow, Dr. E. Headlam. Chronic Bronchitis, etc. 

Gubler, Dr. Adolphe. Commentaires du Codex Medicamentarius, etc., article Col- 
chique. 

Hanbury and Fluckiger. Pharmacographia, p. 636. 

Hammond, Dr. W. A. The Amerian Journal of the Medical Sciences, January, 1859, 
p. 278. 

Husemann, Drs. Theo. and Aug. Die Pflanzenstoffe, p. 493, article Colchicin. 

Stille, Dr. Alfred. Therap. and Materia Medica, fourth edition, vol. ii, p. 658, 
el seq. 

Sarsaparilla. — Sarsaparilla. Root of Smilax officinalis and other 
species of Smilax. Separeille, Fr. ; Sarsaparillwurzel, Ger. 

Decoctum Sarsaparilla} Compositum. — Compound decoction of sar- 
saparilla. (Sarsaparilla, sassafras-root, guaiacum-wood, licorice-root, 
mezereon.) Dose, 1 j — § iv. 

Extractum Sarsaparilla^ Fluidum. — Fluid extract of sarsaparilla. 
Dose, 3 j — 1 ss. 

Syrupus Sarsaparillm Compositus. — Sirup of sarsaparilla. (Sarsa- 
parilla, guaiacum-wood, rose, senna, licorice-root, essential oils.) Dose, 
3 j— 1 ss. 

Extractum Sarsaparillm Compositum Fluidum. — Compound fluid 
extract of sarsaparilla. (Sarsaparilla, licorice-root, sassafras, meze- 
reon.) Dose, 3 ss— 3 ij. 



308 AGENTS INCREASING WASTE. 

Composition. — An alkaloid, parilline, or smilacine, an essential oil, 
starch, resin, oxalate of lime, and extractive matters. From parilline, 
by the action of dilute sulphuric acid, is obtained parigenine, a distinct 
alkaloid. 

Antagonists and Incompatibles. — Alkalies favor the decomposi- 
tion of the decoction and fluid extracts. As there is much starch pres- 
ent in the drug, free iodine should not be prescribed with the official 
preparations. 

Synergists. — Iodine, mercury, and other so-called alteratives, in- 
crease the therapeutical activity of sarsaparilla. Warm clothing in- 
creases the action on the skin ; diluents favor increased urinary dis- 
charge. 

Physiological Actions. — Much discrepancy obtains in the opin- 
ions which have been emitted in respect to the physiological actions 
of sarsaparilla. Surgeons generally hold to its therapeutical powers ; 
physicians are skeptical. The physiological experiments which have 
been made, both with the preparations of the crude drug and with the 
alkaloid, have yielded negative results. Palotta's experiments, made 
with the alkaloid which he had discovered so long ago as 1825, indicate 
that eight grains of the alkaloid produce gastric disturbance, vomiting, 
slowing of the pulse, depression, faintness, and sweating. These re- 
sults have since been in part confirmed by Cullerier. Boecker, how- 
ever, making more systematic examination in accordance with modern 
methods, finds that sarsaparilla is devoid of physiological activity and 
of therapeutical power (Husemann). 

Therapy. — From the point of view of the physiological experi- 
ments it is not difficult to understand the modern incredulity in regard 
to the curative power of sarsaparilla. .The difficulty of distinguishing 
between the post hoc and the propter hoc serves to account for the 
belief still held in some quarters, that this drug is an alterative. Pop- 
ularly, sarsaparilla is supposed to have extraordinary powers as a 
" blood-purifier," and its large use at the present time arises from this 
belief. 

Almost the only use of sarsaparilla at the present time is in the 
treatment of syphilis. It is, of course, not adapted to the primary or 
to the secondary forms. The experience in its favor, even of those 
most confident of its powers, restricts its use to the tertiary form in 
debilitated subjects, who have been broken down by the combined in- 
fluence of syphilis, mercurialism, and iodism. It has been further dem- 
onstrated that the best effects have been obtained by the use of large 
doses of the compound decoction (Allbutt). As the compound decoc- 
tion contains guaiac and mezereon, it is difficult to assign the exact 
share of the sarsaparilla in the result. Furthermore, as a pint or more 
of the compound decoction must be taken in the twenty-four hours, 
these large draughts of a warm liquid are not without influence on the 



GUAIACUM. 309 

functions of the skin and kidneys. It is extremely questionable 
whether sarsaparilla has any therapeutic power ; it is not at all equal 
us an alterative to some of the remedies indigenous in the United 
States, to be considered hereafter. 

The compound fluid extract, the compound decoction, and the 
compound sirup of sarsaparilla, are frequently used as vehicles for 
iodide of potassium and for the bichloride of mercury in secondary 
and tertiary syphilis. 

Scrofula, chronic abscesses, necrosis of bones, old ulcers, and stru- 
mous cutaneous affections, are diseases in which sarsaparilla is sup- 
posed to be efficacious. It is more used as an adjunct to more active 
remedies than depended on alone. 

Authorities referred to : 

Allbutt, Dr. Clifford. TJie Practitioner, 1870, vol. i. 

Gcbler, Dr. Adolphe. Commentaires TJierap. du Codex Medicamentarius y p. 304. 

H anbury and Fluckiger. Pharmacogr aphia, p. 636, et seq. 

Husemann, Drs. Aug. und Theodor. Die PJlanzenstofe, p. 1040. 

Guaiacum. — Guaiac. Gayac, Fr. ; Franzosenholz, Ger. 

Guaiaci Lignum. — Guaiacum- wood. The heart- wood of Guaiacum 
officinale. 

Guiaci Resina. — Guaiac. A peculiar resin obtained from Guaia- 
cum officinale. 

Tinctura Guaiaci. — Tincture of guaiac. (Guaiac, 20 parts ; alco- 
hol, to 100 parts.) Dose, 3 ss — 3 ij. 

Tinctura Guaici Ammoniata. — Ammoniated tincture of guaiac. 
(Guaiac, 20 parts ; aromat. spirit of ammonia, to 100 parts.) Dose, 
3 ss— 3 ij. 

Composition. — The only constituent of interest in the wood is the 
resin. Guaiac has a complex chemical composition. It contains gua- 
iaconic acid (seventy per cent), guaiarec acid, guaiac beta-resin, guaia- 
cic acid, guaiac yellow, gum, etc. 

Antagonists and Incompatibles. — Spirits of nitrous ether and the 
mineral acids are incompatible. 

Synergists. — Agents which promote cutaneous activity are syner- 
gistic. The action of guaiac is much aided by external warmth and 
warm diluent drinks. 

Physiological Effects. — Guaiac has a very acid and pungent 
taste. It excites an abundant flow of saliva. In the stomach it cre- 
ates a sensation of warmth and burning, increases the secretions of the 
gastro-intestinal canal, accelerates the action of the heart, promotes 
diaphoresis, and favors the production and excretion of bronchial mu- 
cus. In large doses it deranges digestion and causes gastric catarrh, 
and in excessive doses the series of symptoms produced by the irritant 
poisons, vomiting, purging, cramps, headache, giddiness, etc. 



310 AGENTS INCREASING WASTE. 

Therapy. — Formerly guaiac was in great repute as a remedy for 
constitutional syphilis. The decoction was drunk in large quantity, a 
very spare diet was enjoined, and the diaphoretic action of the rem- 
edy was aided by external warmth. Doubtless many cases were bene- 
fited by this mode of treatment, but the result was probably less due 
to guaiac per se than to the regimen. 

Its present use as an anti-syphilitic remedy is confined to the prep- 
arations of sarsaparilla, in which it enters as a constituent. 

Recent clinical experience has shown that guaiac is a capital rem- 
edy in tonsillitis. Given in a half-drachm dose (tincture) every four 
hours, it appears to abate the inflammation and to cut short the dis- 
ease in a remarkable manner. It is a very acrid and disagreeable rem- 
edy, and should be given in emulsion, with mucilage or yolk of egg, 

Guaiac is a useful remedy in dysmenorrhea, when the pain is due 
to rheumatism or neuralgia, and is of course not adapted to those 
cases in which there is narrowing of the cervical canal. 

Lastly, guaiac is used with varying degrees of success in chronic 
gout, chronic rheumatism, lumbago, sciatica, gouty bronchitis, etc. As 
we have so many more efficient and pleasant remedies for these dis- 
eases, it will rarely be necessary to resort to guaiac. 

Authorities referred to : 

Carter, Mr. The Practitioner, vol. iv, p. 190. 

Fluckiger and Hanbury. Pharmacographia, p. 92, et seg. 

Husemann, Drs. Aug. und Theo. Die Pjlanzenstoffe, p. 712. 

Stille, Dr. A. Therapeutics and Materia Medica, fourth edition, vol. ii, p. 594. 

Stillingia. — Root of Stillingia sylvatica. Yaw-root, queen's root. 

Extractum Stillingiw Fluidum. — Fluid extract of stillingia. Dose, 
m x— 3 j. 

(The above is the only preparation recognized by the United States 
Pharmacopoeia. A tincture may be made of two ounces of the bruised 
root to a pint of diluted alcohol, of which the dose is 3 ss — 3 ij. A 
decoction may be made as follows : one ounce of the bruised root to 
two pints of water, boiled down to one pint, of which the dose is § ss 
— § ij. All the preparations should be made of the fresh root, as the 
activity of the drug is diminished by drying.) 

Composition. — The plant yields on incision a milky juice, which 
appears to possess the medicinal properties of the drug. The so-called 
stillingin of the eclectics is not the active principle, but an extract. 
The active principle has not yet been isolated. 

Physiological Effects. — The juice of the plant has an acrid, pun- 
gent taste, leaving a persistent after-taste of great activity. It excites 
an abundant flow of saliva. In the stomach a feeling of warmth fol- 
lows its use, and the secretions of the organ are increased in amount. 
In full doses it excites nausea and vomiting, epigastric pain, and an 



STILLINGIA. 311 

acrid, burning sensation in the fauces. It increases the secretions of 
the intestinal canal, notably of the liver, and, in full doses, purges, the 
fseces having the appearance of the so-called "bilious stools." In- 
creased action of the heart follows the introduction of the active prin- 
ciple into the circulation, and the skin becomes warm and moist. The 
bronchial mucous membrane exhales a larger quantity of mucus, and 
the kidneys become more active, excreting an increased quantity of wa- 
ter and solids. It may, therefore, with propriety be grouped with the 
so-called alteratives. 

Therapy. — Stillingia is certainly a very valuable remedy. It has 
long had a local reputation in the Southern Atlantic States as an al- 
terative. 

In habitual constipation, due to deficient secretion of the intestinal 
mucous membrane, it may be used with advantage. The torpidity of 
the liver and jaundice, which follow attacks of intermittent fever, are 
removed by stillingia. This agent also renders important service in 
the first stage of cirrhosis, and in ascites due to the hepatic changes. 
Hemorrhoids, when produced by obstructive difficulty in the liver, 
may be removed temporarily, and, if due to constipation, may be re- 
moved permanently, by stillingia. 

In habitual constipation the following formula is useful : Ijt Ext. 
stillingise fl., 3 v ; tinct. belladonna? ; tinct. nucis vom. ; tinct. physostig- 
matis, aa 3 j. M. Sig. : Twenty drops, in water, three times a day be- 
fore meals. When the biliary secretion is deficient, the following : I£ 
Ext. stillingia? fl., 3 v ; tinct. aloes, 3 ij ; tinct. nucis vom., 3 j. M. 
Sig. : Twenty drops, in water, three times a day. 

Stillingia has long been in popular repute as an alterative, and em- 
ployed in domestic practice as a remedy for scrofula in its various 
forms. The success which has attended its employment in some de- 
gree justifies the high encomiums which have been bestowed on it. 
It is very serviceable in children who present the following symptoms : 
enlarged cervical glands, mucopurulent discharge from the nose, with 
excoriations of the surrounding integument, a pasty complexion, ca- 
pricious and unnatural appetite, tumid abdomen, whitish and pasty 
stools j dull-red, soft, and tubercular eruption on the shin, ulcerating 
and furnishing a large quantity of unhealthy pus. The steady use 
of stillingia, combined with suitable hygienic means, will accomplish 
important relief in such cases*. 

The most satisfactory results have been obtained from the use of 
stillingia in syphilitic affections. It is applicable to the same condi- 
tions under which the preparations of sarsaparilla are now used, viz., 
in chronic cases of the secondary and tertiary form, the patients hav- 
ing been broken down by the long-continued use of mercurials and 
iodides. Repeated observation of cases in which it was used as the 
sole agent has satisfied me of its curative value. It differs from the 



312 AGENTS INCREASING WASTE. 

compound decoction of sarsaparilla in this, that its effect is distinctive, 
and is not due to the use merely of a large quantity of fluid. The 
eminent Dr. Porcher, of South Carolina, thus expresses himself with 
regard to the use of stillingia in syphilitic affections : " I have em- 
ployed the decoction of the root of this plant as an alterative in syphi- 
litic sores, occurring in patients in the City Hospital, Charleston, the 
spread of which nothing else could arrest. It proved completely satis- 
factory. Phagedenic chancres were rapidly cured under its use. A 
strong decoction was given three times a day, with four drops of nitric 
acid to each dose." 

A strong infusion or decoction of stillingia is said to be effective 
in preventing the development of a paroxysm of ague, if taken before or 
just as the chill is beginning. It is reported that profuse diaphoresis 
is produced and the impending attack is averted. The fluid extract 
of stillingia may be given in combination with quinine or arsenic in 
intermittents. • 

Authorities referred to : 

Porcher, Dr. Francis Petre. Resources of the Southern Fields and Forests, Charles- 
ton, 1869, p. 146. 

Sanguinaria. — Blood-root. The rhizoma of Sanguinaria cana- 
densis Linne (Nat. Ord. Papaveraceoi), collected in autumn. (U. S. P.) 

Tinctura Sanguinarim. — Tincture of sanguinaria. Dose, in, v — 
3 ss. 

Acetum Sangui?iarice. — Vinegar of sanguinaria (sanguinaria, 10 
parts ; diluted acetic acid, sufficient to make 100 parts). Dose, tti v — 
3 ss. 

Extractum Sanguinariaz Fluidum. — Fluid extract of sanguinaria. 
Dose, t\[ ij — ill, xx. 

Composition. — Sanguinaria contains an alkaloid, sanguinarine, 
which appears to be identical with the ehelerythrine of Probst. San- 
guinarine is a white, pearly substance of an acrid taste, very sparingly 
soluble in water, soluble in ether, and very soluble in alcohol. With 
the acids it forms salts soluble in water, all of which have some shade 
of red, crimson, or scarlet, and form beautiful red solutions. Another 
alkaloid, named porp>hyroxine (sanguinaria-porphyroxin — Husemann), 
has been found by Riegel. Besides these alkaloids, sanguinaria con- 
tains a peculiar acid, chelidonic, and another has been announced, for 
which the name sanguinarinic acid has been proposed, but this latter 
acid has been shown to be a mixture of malic and citric acids. The 
alkaloids exist in the root in combination with these acids — the most 
important compound being the chelidonate of sanguinarine. Besides 
the foregoing, blood-root contains the following unimportant constitu- 
ents : resin, gum, extractive, albumen, sugar, etc. 



SANGUINARIA. 313 

Antagonists and Incompatibles. — Alkalies, tannic and gallic 
acids, and most of the metallic salts, are chemically incompatible with 
the preparations of blood-root. The local irritant action of the drug 
and the depression of the circulation which it causes are antagonized 
by opium, by amyl nitrite, by atropine, etc. 

Synergists. — The mineral and vegetable emetics, the so-called 
alteratives of the vegetable kingdom, and the mineral salts, considered 
from the therapeutical point of view, promote the physiological and 
therapeutical effects of sanguinaria. 

Physiological Effects. — Sanguinaria has a bitter, acrid taste, 
which persists for a long time. When swallowed, it leaves a sense of 
constriction and acridity in the throat. It excites a feeling of heat in 
the stomach, and stimulates secretion of the mucous membrane. If the 
quantity taken is insufficient to produce nausea, the action of the heart 
is increased, and a subjective sensation of warmth is experienced 
throughout the system. In considerable doses sanguinaria is an active 
emetic, producing much nausea and depression, and slowing the action 
of the heart. It is very irritating to the mucous membrane. Snuffed 
up the nose, it produces violent sneezing. In large doses it inflames 
the stomach, producing intense burning, with thirst, great prostration, 
dimness of vision, vertigo, and collapse. 

The alkaloid, sanguinarine, manifests all the physiological capa- 
bilities of the drug. It has an intensely bitter, acrid taste. In small 
doses (one twelfth to one eighth of a grain) it simply increases secre- 
tion of the gastro-intestinal mucous membrane ; in doses of one sixth 
to one fourth of a grain it causes depressing nausea and sometimes 
vomiting. In large doses it produces, in addition to the gastric symp- 
toms mentioned above, slowing and irregularity of the pulse, cold 
sweats, cold extremities, vertigo, dilated pupils, anxiety, etc. 

Applied to fungous granulations, sanguinaria has considerable es- 
charotic power. 

The sketch above given of the physiological actions of sanguinaria, 
which embodies the results of the author's investigations and clinical 
studies, requires no special modification. The recent elaborate and 
most thorough research of Dr. Robert Meade Smith confirms the 
author's account. The reader who wishes to exhaust the subject will 
find that nothing has been omitted by Dr. Smith. 

Therapy. — In atonic dyspepsia from two to five drops of the tinc- 
ture, or the one twelfth of a grain of sanguinarine, may be used with 
advantage. It promotes secretion, and increases the appetite. There 
seems no doubt, according to the author's observation, that sanguinaria 
promotes the hepatic and intestinal secretions. It is, therefore, a ser- 
viceable remedy in duodenal catarrh, and secondary catarrh of the 
biliary ducts with jaundice. 

Its most important therapeutical effects are witnessed in diseases of 



314 AGENTS INCREASING WASTE. 

the respiratory organs. Chronic nasal catarrh is successfully treated 
by the internal use of the tincture (ten drops ter die), or of the alkaloid 
(one fifteenth of a grain ter die), and the local application of the pow- 
der, in small quantity, applied by an insufflator to the Schneiderian 
mucous membrane. In acute bronchitis (catarrh), after the subsidence 
of the more acute symptoms, it is a serviceable expectorant. It may 
be combined with other expectorants and alterants : fy Tinct. sangui- 
naria?, 3 j ; tinct. lobelia, 3 j ; vini ipecac, 3 ij ; syrup, tolutan., § ss. 
M. Sig. : A teaspoonful every three hours as an expectorant. In 
humid asthma the following combination is extremely serviceable : Tfr 
Tinct. sanguinaria?, 3 j ; tinct. lobelia?, 3 j ; ammonii iodidi, 3 j ; syrup, 
tolutan., 3 vj. M. Sig. : A teaspoonful every two, three, or four hours. 
In spasmodic asthma the same prescription is occasionally very effect- 
ual, but the author is unable to indicate the precise condition under 
which it is most useful. 

Sanguinaria has been proposed as an emetic in croup. It is, how- 
ever, too uncertain in action, and too harsh, to justify its use when 
there are so much more eligible remedies at hand. 

The emmenagogue properties of sanguinaria seem well established. 
It is indicated when amenorrhcea is functional in character, when 
there is an absence of plethora, and when no malformation exists. It 
may be advantageously combined with aloes, provided there is no con- 
traindication to the use of the latter. $ Tinct. sanguinaria?, 3 ij ; 
tinct. aloes, § ss ; tinct. nucis vom., 3 ij. M. Sig. : Ticenty drops two 
or three times a day, in amenorrhcea of anaemia, or chlorosis. Or the 
following : I£ Sanguinarina?, grs. ij ; ext. aloes, grs. x ; ferri redacti, 
3j. M. Ft. pil. no. xx. Sig. : One pill three times a day. 

Sanguinaria has decided aphrodisiac properties. When there are 
relaxation of the genital organs, diurnal losses, inaptitude (from irrita- 
bility) for coitus, sanguinarine may be given as follows : $ Ergotin 
(aq. ex.), 3j ; sanguinarina?, grs. ij. M. Ft. pil. no. xx. Sig. : One, 
three times a day. As stillingia appears to have similar properties as 
an aphrodisiac, the following combination will prove useful : ^ Tinct. 
sanguinaria?, 3 iij ; ext. stillingia? fl., 3 v. M. Sig. : Fifteen to twenty 
drops, in water, three times a day. 

As an alterant in chronic syphilitic and strumous affections, san- 
guinarine may be used in the same class of cases as sarsaparilla, guaiac, 
and stillingia. It is an important addition to a decoction of woods in- 
digenous to our soil, used as a substitute for the more expensive and 
really less efficient foreign drugs of the same group. 

Local Applications. — Sanguinaria, having feeble escharotic prop- 
erty, is used as a local application to repress exuberant granulations, 
and to ill-conditioned ulcers to change their character. Several cases 
have been reported, indicating the power of sanguinaria to repress the 
growth and destroy nasal polypi. 



XANTHOXYLUM. 315 

A decoction of sanguinaria is a useful gargle in the sore-throat 
of scarlatina. 

Authorities referred to : 

Husemann, Drs. Aug. und Theo. Die Pfanzenstqfe, p. 199. 

Porcher, Dr. Francis Peyre. Resources of the Southern Fields and Forests, p. 31, 
ei seq. 

Phillips, Dr. C. D. F. Materia Medica and Therapeutics, London, 1874, p. 143. 

Stille, Dr. Alfred. Therapeutics and Materia Medica, fourth edition, vol. ii, p. 454. 

Smith, Dr. Robert Meade. The Physiological Action of Sanguinarina. Tlie Am. 
Jour. Med. Scl, October, 1876, p. 346, et seq. 

Xanthoxylum. — Prickly ash. The bark of Xanthoxylum fraxi- 
neum Willdenow and of X. carolinianum Lambert (Nat. Ord. Ruta- 
cece, Xanthoxylem). 

Extr actum Xanthoxyll Fluidum. — Fluid extract of xanthoxylum. 
Dose, in x — 3 j. 

A decoction may be made by boiling an ounce of the bark in a 
quart of water down to one pint, and of this one to two ounces may 
be used every four hours. A tincture may also be prepared with two 
ounces of the root to a pint of diluted alcohol, of which the dose would 
be 3 ss — 3 ij. The official fluid extract is more frequently in use ; the 
dose of this is xn, xv — 3 ij. 

Composition. — Xanthoxylum contains a neutral crystallizable prin- 
ciple, which is known as xanthoxylin, and is said to be identical with 
xanthopicrite, and the latter has been shown to be berberine. Besides 
this important constituent, a volatile and a fixed oil, resin, gum, etc., 
are contained in it. 

Physiological Actions. — The taste of xanthoxylum is at first 
sweetish, and somewhat aromatic, but considerable bitterness is soon 
developed, followed by acridity, which remains long in the fauces. It 
has remarkable sialagogue property, and the increased flow of saliva 
occurs from the systemic effects, as well as from the local impression 
on the mucous membrane of the mouth. In the stomach it excites a 
sensation of warmth, and increases secretion from the stomach and in- 
testinal mucous membrane. It is in a high degree probable that just 
as its presence in the mouth causes salivation, so its presence in the 
intestinal canal determines the flow of gastric, duodenal, hepatic, and 
pancreatic secretion. The action of the heart is increased by xan- 
thoxylin, the arterial tension rises, the capillary circulation becomes 
more energetic, and the sweat-glands are made to pour forth a more 
abundant secretion. Corresponding effects are produced in the kid- 
neys, and increased flow of urine follows its administration. 

Therapy. — Xanthoxylum is a domestic remedy for toothache. The 
bark, chewed, has a popular reputation for paralysis of the tongue. A 
decoction of the bark is an efficient local application to the throat when, 



316 AGENTS INCREASING WASTE. 

in cases of chronic pharyngitis, there is dryness of the mucous mem- 
brane. From ten to thirty minims of the fluid extract, or a half to one 
drachm of the tincture, ter in die, is a successful remedy for an ex- 
tremely obstinate affection, namely, chronic pharyngitis — the mucus 
adhering in large, thin, dry scales, and the mucous membrane being 
glossy, shining, glazed, and dry. 

The active principle (xanthoxylin) is a useful stomachic tonic in 
atonic dyspepsia. When, however, in stomach, intestinal, or hepatic 
disorders the object is to promote secretion, the preparations of xan- 
thoxylum must be used. Jaundice due to catarrh of the bile-ducts, and 
that form of jaundice produced by acute malarial poisoning, are con- 
ditions in which xanthoxylum is distinctly remedial. Constipation, 
due to deficient secretion, is also removed by this agent. 

Xanthoxylum has long had a deserved reputation in the treatment 
of chronic rheumatism. It is adapted to muscular rheumatism, myal- 
gia, and such local muscular disorders as torticollis (recent cases), lum- 
bago, etc. It may be used with advantage, locally, in these affec- 
tions. The curative power which it possesses in chronic rheumatism 
is doubtless due to its eliminant action on the mucous and cutaneous 
surfaces. 

Xanthoxylum is a remedy for constitutional syphilis of equal merit 
with guaiac, mezereon, stillingia, etc., and is greatly more effective 
than sarsaparilla. 

Decoction of xanthoxylum has been used with success in the treat- 
ment of dropsy. 

Fraxinus Americana. — The inner bark of the root. (Not official.) 

Preparation. — Vinum Fraxini. The inner bark of the root col- 
lected in November, eight ounces ; stronger white wine, or sherry, 
two pints. The root-bark should be macerated in the wine three or 
four days ; after percolation, to every 25 parts there should be added 
2 parts of glycerin and 1 part of alcohol. The dose of the wine thus 
prepared is a teaspoonful or two, three times a day, before meals. 

Actions and Uses. — There has been no adequate study of the 
physiological actions of fraxinus. Its employment is, thus far, merely 
empirical. We owe to Dr. Charles P. Turner, of Philadelphia, the 
knowledge now in our possession regarding its therapeutical powers. 
It belongs to the group of alterative medicines, if we may still use this 
rather obsolete term. Administered in certain diseases, it modifies the 
local morbid process, or cures it without any recognizable disturbance 
of the functions. The chief use of it thus far has been in the treat- 
ment of certain uterine disorders. Dr. Turner has found it to have a 
curative action in chronic metritis, and in the disorders consequent on 
this condition of the uterus. In the various forms of dysmenorrhoea, 
especially the congestive variety, it has proved to be very effective. 
Lest disappointment may be experienced from its use, we assure our 



ANTISEPTICS. 317 

readers that the administration of the wine must be kept up for several 
weeks or months. When administered for dysmenorrhoea, it should 
be taken diligently in the interval, and when given for metritis, it 
should be taken assiduously for several months. 

Authorities referred to : 

Husemann, Drs. Aug. und Theo. Die Pflanzensloffe, pp. 80, 7 IT, 1108. 
Porcher, Dr. F. Peyre. Resources of the Soidhem Fields and Forests, p. 161. 



AGENTS HAVING THE POWER TO ARREST SEPTIC 
PROCESSES, AND TO DESTROY THE FERMENTS 
OR THE MINUTE ORGANISMS (DISEASE-GERMS), 
ON THE PRESENCE OF WHICH THEIR ACTIVITY 
DEPENDS. 

ANTISEPTICS. 

Those remedies are entitled antiseptic which are employed to ar- 
rest fermentative processes. It is now generally admitted that every 
kind of fermentation is correlative of the growth and multiplication 
of a living organism. In various diseases, microzymes, vibrio, bac- 
teria, either stand in a causative relation to the morbid process, or are 
necessary to its evolution and development. As an exemplification of 
the influence exerted by these minute organisms in diseased states, I 
may mention the bacteria of Oertel, which are formed in such immense 
numbers, and attain to such wide diffusion in diphtheria ; the protomy- 
cetes of Obermeier, which play so important a role in relapsing fever ; 
the bacillus malarise of Klebs and Tomassi-Crudeli; the bacillus tubercu- 
losis of Koch, and the specific bacteria (cacobacteria) found by Burdon- 
Sanderson in the exudation of septic inflammation of the peritonseum. 
Disease-germs, which may not exist in definitely-organized forms, 
are, at least, constituted of living matter, having properties apparently 
similar to those ferments with which chemistry has made us acquainted. 
Increased importance is given to the subject of ferments, by the dis- 
covery of ptomaines — alkaloidal substances found in the body after 
death — and by those poisons generated in the course of the septic dis- 
eases which have, apparently, a similar genesis. Although for many 
specific and communicable diseases the pathogenetic germs remain un- 
known, sufficient facts have been collected to justify the theory of 
the existence of such organisms. 

The remedies of this group — antiseptica — have the power, when 
brought into contact with the minute organisms or disease-germs men- 
tioned above, to destroy their vitality, and to arrest the fermentation 
process, or zymosis, which they either initiate or promote. There is a 
distinct relation between the antiseptic and antipyretic properties of 



318 ANTISEPTICS. 

various members of this group, and they have the power to depress 
temperature in the same ratio that they are active in destroying dis- 
ease ferments and germs. Some of these remedies, e. g., quinine, sul- 
phurous acid, the sulphites, etc., have already been discussed in Part 
II. Under this head there remain for consideration several important 
agents whose applications are distinctly antiseptic. 

Oxygenium.— Oxygen. Oxyglne, Fr.; Sauerstoff, Ger. (Not official.) 

Preparation.— The most convenient mode of preparing oxygen 
for medical purposes is to heat in a gun-barrel-shaped brass or iron re- 
tort a mixture composed of five parts of chlorate of potassium and 
one part of binoxide of manganese. When heated to dull red, the 
chlorate yields up its oxygen, being reduced to chloride. The gas may 
be most conveniently collected over water, which dissolves but little 
of the oxygen, but takes up all the chlorine that may be accidentally 
present. 

It is a permanent, elastic gas, inodorous, without taste, incombus- 
tible, but uniting with bodies in a state of combustion. It is very 
slightly soluble in water at the ordinary temperature and pressure. 

Dose. — The quantity of oxygen which may be inhaled, in the or- 
dinary medicinal applications of this gas, ranges from one to five gal- 
lons. The simplest apparatus will suffice, but an elastic bag, with a 
suitable mouth-piece, is usually employed for this purpose. 

Physiological Actions. — If the important role which oxygen 
plays in the economy of Nature furnished a measure of its powers 
when administered as a remedy, it would be a most important thera- 
peutic agent. When inhaled in the pure state (not as air), it produces 
singularly little constitutional disturbance. A sensation of warmth in 
the larynx, trachea, and bronchi, is first experienced ; the pulse, as a 
rule, somewhat increases, though it may be lessened in frequency ; a 
sense of mental exhilaration and a disposition to greater bodily activity 
are produced ; the appetite becomes keener ; but no constant influ- 
ence on the excretions has been noted (Demarquay). Experiments 
on animals have demonstrated that the inhalation of oxygen per se 
does not have an injurious effect on animal life (A. H. Smith). On 
the contrary, as Hayem has recently shown, the administration of 
oxygen in from forty to ninety litres per day, given in two doses and 
mixed with a determinate quantity of air, energizes to a considerable 
degree the nutritive functions ; it increases the appetite, slightly ele- 
vates the temperature, stimulates the cardiac movements, and aug- 
ments the body-weight. These results are due in the main to the ef- 
fect of oxygen on the blood ; it increases the number and stimulates 
the organic activity of the red blood-globules. Although this action 
is not constant, the effects may become so by the greater nutritional 
changes which are thus promoted. When the inhalations are sus- 



OXYGEX. 319 

pended, these effects on the blood cease. Anne's results, obtained by 
a course of experiment on himself, entirely confirm those obtained by 
Hayem. 

Therapy. — Oxygen is indicated and has been used with success in 
diseases of the respiratory organs, characterized by dyspnoea, due to 
causes interfering with the oxygenation of the blood, in emphysema, 
asthma, croup, asphyxia, chloroform narcosis, asphyxia from toxic 
gases, etc. In these cases oxygen acts in a manner which is perfectly 
obvious : the labor of breathing and the damage to the respiratory 
center are lessened by the addition to the blood of oxygen in larger quan- 
tity than is supplied by the air. In these cases, pure oxygen, or a mix- 
ture of one part of the gas to two or three of air, may be employed. 
The more extreme the dyspnoea, the greater the necessity for undi- 
luted oxygen. 

Oxygen is also indicated, and has been successfully employed, in 
certain diseases characterized by insufficient oxidation : chlorosis, ance- 
mia, leucocythemia, diabetes, albuminuria, etc. In such cases the in- 
ternal administration of chalybeate medicines, or mineral waters, 
should accompany the inhalations of oxygen. Pure oxygen is not ne- 
cessary ; an admixture with three parts of air will suffice, and the 
inhalation should be made morning and evening. 

The evidence is satisfactory that oxygen-inhalations produce good 
results in some cases of phthisis. Those cases appear to be most bene- 
fited in which emaciation, dyspeptic symptoms, etc., have occurred, 
without marked change in the condition of the lungs. When hectic 
fever comes on, and excavations have occurred, the utility of oxygen 
has ended, except as a palliative of dyspnoea. Pinard reports a case 
of vomiting of pregnancy, uncontrollable by other means, promptly 
arrested by oxygen inhalations. Hayem gives similar facts, and also 
reports the good effects of this remedy in gastralgia, dyspepsia, and 
other functional disorders of the stomach. In cancer, chronic catarrh, 
and dilatation of the stomach, it affords relief without having a cura- 
tive action. 

Authorities referred to : 

Andrews, Dr. J. B. Tlie Detroit Review of Medicine and Surgery, December, 1S71, p. 571. 

Anne, Dr. Henri. These de Paris, 1880. 

Birch, Dr. TJie Therapeutic Action of Oxygen, London, 1857. TJie British Medical 
Journal, December 24 and 31, 1859. 

Bricheteau, Dr. F. Bulletin General de Th'erapeutique, vol. lxx, p. 162. 

Demarquay, Dr. Essai de Pneumatologie Medicate, etc., Paris, 1866. 

Hackley, Dr. C. E. New York Medical Journal, vol. ix, p. 597. 

Mackey, Edward. The Practitioner, vol. ii, p. 278. 

Pinard, Dr. Annuaire de Therapeutique, 1881, p. 109. 

Smith, Dr. A. H. Neva York Medical Journal, vol. xi, p. 152. 

Waldenburg, Dr. L. Die locale Behandlung der Krankheiten der Athmungsorgane, 
Berlin, 1872, p. 690, etscq. 



320 • ANTISEPTICS. 

Chlorinium.— Chlorine. Chlore, Fr. ; Chlor, Ger. (Not official.) 

Properties. — Chlorine is a greenish-colored gas, of a persistent, 
penetrating, suffocating, and characteristic odor. It is soluble in water 
in the proportion of two volumes (of gas) to one. 

Aqua Chlori. — Chlorine-water is a greenish-yellow liquid, possess- 
ing the suffocating odor of chlorine. 

Liquor Sodw Chloratce. — Solution of chlorinated soda. A trans- 
parent liquid, of a greenish-yellow color, having a slight odor of chlo- 
rine, a sharp, saline taste, and an alkaline reaction. 

Calx Chlorata. — Chlorinated lime. Chloride of lime. A grayish- 
white substance, in powder or friable lumps, dry or but slightly moist, 
and nearly entirely dissolved by dilute muriatic acid, with the escape 
of chlorine. It should contain at least 25 per cent of chlorine. 

Physiological Actions. — Chlorine as a gas, or in solution in wa- 
ter, is an active irritant. Applied to the skin for some minutes, it 
causes heat and burning, increased diaphoresis, and, if the contact be 
sufficiently prolonged, vesication. Inhaled in very small quantity, 
largely diluted with air, this gas induces a sensation of warmth in the 
chest, and increases the bronchial mucus. In considerable quantity it 
is a violent irritant, excites spasm of the glottis, and sets up active 
inflammation of the larynx, bronchi, and lungs. 

Chlorine is without action when moisture is not present. Water is 
decomposed by it, chlorhydric acid is formed, and oxygen set free as 
active oxygen or ozone. The antiseptic and antiferment properties of 
chlorine are, therefore, due to the oxidizing powers of the liberated 
ozone. The sulphur and phosphorus compounds with hydrogen are 
decomposed by chlorine. When this gas is brought into contact with 
sulphureted hydrogen, chlorhydric acid is formed and sulphur is pre- 
cipitated. On these chemical facts rest the deodorant and disinfectant 
powers of chlorine. Binz has lately made an elaborate study of the 
effects of chlorine, and he finds that in animals it has a distinct nar- 
cotic effect ; that it suspends the functions of the cerebrum, but does 
not impair the contractility of muscle, or the irritability of nerves. 

Therapy. — Chlorine gas will arrest putrefactive decomposition of 
animal matters, and may, therefore, be employed as a preservative of 
anatomical preparations. As a deodorant and disinfectant it may be 
used to destroy foul effluvia and disease- germs. It is irrespirable in 
sufficient quantity to affect disease-germs in the living subject, and it 
destroys the colors and even texture of fabrics, so that it is rarely used 
for disinfection of the person or of the clothing of patients. 

Chlorine- water, chlorinated soda, and solutions of chlorinated lime, 
are employed locally in scarlet fever, diphtheria, aphthae, and gangrene 
of the mouth and fauces. Their chief utility consists in removing 
fetor, but they probably, also, exert a toxic influence on disease-germs. 
3 Aquae chlori, § ss ; aquse destil., 1 iijss ; syrupi simpl., § ss. M. 



BROMINE. 321 

Sig. : As a gargle or lotion for the mouth. ^ Calc. chloratse, 3 ss ; 
mucilaginis, 3 ss ; aquae destil., § iijss. M. Sig. : Lotion. To correct 
fetor of the breath, the following formula may be used : I£ Calcis 
chlorat., 3 iij ; aquas destil., alcoholis, aa § ij ; ol. rosoe, gtt. iv. M. 
Sig. : A teaspoonful to a tumblerful of water. 

Chlorine-water was formerly much employed in scarlet fever, ty- 
phoid, typhus, etc. Its use in these affections was predicated on its 
presumed power to arrest the zymosis of the morbid ferments. It 
need hardly be stated that such notions are no longer entertained. 

These chlorine preparations are unquestionably serviceable as deter- 
gent, deodorant, and antiseptic applications to sloughing and gangre- 
nous wounds. A solution of chlorinated soda is employed to prevent 
infection by animal poisons, the bite of serpents and insects, and the 
syph Hit ic v irus. 

Formerly chlorine-water and chlorinated soda were used in chronic 
hepatic affections, but there is no evidence that they are serviceable. 

The toxic effects of chlorine gas may be prevented by ammoniacal 
gas, forming ammonium chloride. Albumen is the most suitable and 
convenient antidote to the chlorine preparations taken into the stom- 
ach. It should be given freely in the form of milk, eggs, flour, etc. 

Bromum. — Bromine. Brome, Fr.; Brom, Ger. A dark-red liquid, 
having a strong, disagreeable odor. It is sparingly soluble in water, 
more soluble in alcohol, and still more so in ether. 

Physiological Actions. — The actions of bromine, considered from 
the chemical point of view, are similar to those of chlorine ; it decom- 
poses hydrogen compounds, forming bromhydric acid, and precipitating 
or separating the element associated with hydrogen. It is therefore a 
deodorant and antiseptic. The vapor of bromine is intensely irritant 
to the air-passages. It combines with the water and sets free ozone, 
which energetically attacks the mucous membrane. In sufficient quan- 
tity, laryngitis, bronchitis, and pneumonia will be produced by the 
inhalation of its vapor. Applied in the liquid form, and undiluted, 
bromine acts as an energetic and very painful escharotic. A brownish 
slough is formed, which is afterward slowly detached. Internally, by 
the stomach, bromine acts as a corrosive poison, producing violent gas- 
tritis, and the phenomena of depression and collapse, which attend the 
action of corrosive poisons in general. 

Therapy. — The vapor of bromine is an efficient remedy in acute 
coryza and hay-asthma: $ Bromi, 3 ss ; alcoholis, 3 iv. M. Sig.: 
For^ inhalation. A small quantity of this solution may be placed in 
a wide-mouthed vial, and vaporized by the warmth of the hand. The 
vapor should be snuffed into the nose. It probably acts, as already 
explained, by setting free ozone. The activity of the pollen of plants, 
the presence of which gives rise to the symptoms of hay-asthma, is 
21 



322 ANTISEPTICS. 

destroyed. The offensiveness of an ozoena may be removed by the 
same expedient. Chronic nasal catarrh may not unfrequently be 
greatly benefited by the vapor of bromine. Hammond has proposed 
the internal use of a solution of bromine, as a substitute for the bro- 
mides in the treatment of epilepsy. Besides its disagreeable qualities, 
and its irritant action, it has no advantages over the bromides. 

The most important use of bromine is as an escharotic. For the 
destruction of chancre, it is probably the best caustic. Hospital gan- 
grene, the experience of the rebellion demonstrated, was more certainly 
arrested by bromine than by any other escharotic. 

For the destruction of carcinoma uteri, this agent is preferred by 
some eminent gynaecologists. When used for these purposes, pure bro- 
mine is applied, by means of a glass rod, thoroughly, to the diseased 
or sloughing or gangrenous surface. 

The objections to the use of bromine are its fetid odor, its vola- 
tility (boils at 117° Fahr.), and the pain which attends its escharotic 
action. 

Acidum Carbolicum. — Carbolic acid. Phenique acide, Fr. ; Carbol- 
sdure, Ger. A product of the distillation of coal-tar. Is either in 
acicular crystals or in crystalline masses ; white or colorless when 
perfectly pure, but, even when slightly impure, either reddish or be- 
coming so on exposure ; deliquescent and readily assuming the liquid 
state in the presence of a little water, yet not dissolving ; of a strong 
odor and taste, recalling those of creosote, but distinct ; fusible at 
from 93° to 106°, forming an oily liquid. It is soluble in from twenty 
to thirty-three parts of water, the purest being most soluble. Alcohol, 
ether, chloroform, glycerin, and the essential oils, dissolve it freely. 
It combines with alkalies and other salifiable bases, but its compounds 
have still an alkaline reaction and are decomposed by the feeblest acids, 
even by carbonic acid. Dose, gr. \ — gr. j. 

Acidum Carbolicum Crudum. — Impure carbolic acid. Is either 
colorless or has a brown shade. It consists of carbolic and cresylic 
acids, in variable proportion, with impurities derived from coal-tar, 
which vary from ten to thirty per cent. 

Glyceritum Acidi Carbolici. — Glycerite of carbolic acid (not of- 
ficial), ( | ij carbolic acid ; half a pint of glycerin). 

Aqua Acidi Carbolici. — Carbolic-acid water (not official), (glycer- 
ite of carbolic acid, 3 x ; water, one pint). Dose, a teaspoonful to a 
half-ounce. 

Unguentum Acidi Carbolici. — Ointment of carbolic acid. (Car- 
bolic acid, 10 parts ; ointment, 90 parts.) (IT. S. P.) 

Creosotum. — Creosote. A product of the distillation of wood-tar. 
A colorless, oily, neutral liquid, having a strong, characteristic odor, 



CARBOLIC ACID. 323 

and an acrid, burning taste. Is sparingly soluble in water, but mixes 
in all proportions with alcohol and ether. 

It is distinguished from carbolic acid, which it in some respects 
closely resembles, by not coagulating collodion when mixed with it, 
and by not imparting a blue color to a slip of pine-wood dipped first 
into an alkaline solution of creosote, and then, after drying, into mu- 
riatic acid. 

Aqua Creosoti. — Creosote-water (creosote, 1 part ; distilled water, 
99 parts). Dose, a teaspoonful to an ounce. 

Carbolic acid has largely superseded creosote as a remedy. 

Antagonists and Incompatibles. — Combination with alkalies di- 
minishes, but does not entirely check, the physiological activity of 
carbolic acid. Saccharate of lime, or lime, is probably the most effi- 
cient antagonist from the chemical point of view (Th. Husemann). 
In cases of poisoning, this substance should be given freely. The 
mucous membrane should be protected as far as possible by the ad- 
ministration of vegetable demulcents, but not by oils and glycerin, 
which favor absorption. I am indebted to Dr. A. C. Post, of New 
York, in a verbal communication, for the important fact that atropine 
is a physiological antagonist to the systemic symptoms induced by 
carbolic acid. He was induced to administer atropine in a case of 
poisoning by carbolic acid, on observing the minutely contracted pu- 
pils and the failing circulation. The result was successful. Similar 
success has attended the same practice in other cases. Experiments 
on animals have also demonstrated the existence of this antagonism, 
which may now be regarded as an established fact. The rules for 
guidance in the administration of atropine are the same as in other 
cases : a sufficient quantity of the antagonist is administered to main- 
tain dilatation of the pupil and to overcome the depression of the cir- 
culation and respiration. Elimination should also be promoted by the 
free use of diluents. 

Synergists. — All of the phenols, the antiseptics, the motor depres- 
sants, etc., increase the effects of carbolic acid. 

Physiological Actions. — Applied to the integument or to the 
mucous membrane, carbolic acid produces a burning sensation of 
short duration, and there is formed a whitish, superficial eschar, which 
subsequently becomes brownish. The taste of carbolic acid is sweet- 
ish, cooling, and then pungent and hot. When swallowed by accident 
or design, the mucous membrane appears as if brushed over with a 
strong solution of nitrate of silver, and becomes hard and dry like 
leather. This appearance is observable about the lips, fauces, the 
oesophagus, the cardiac and pyloric extremities of the stomach, and 
the summits of the folds of the mucous membrane in the organ gen- 
erally. This change in the condition of the membrane is due to the 
power of carbolic acid to coagulate the albumen of the tissues. Vom- 



324 ANTISEPTICS. 

iting is not constant, even when toxic doses are swallowed, and the 
vomited matters smell of the poison. From medicinal doses, a cooling, 
rather grateful sedative effect is experienced in the stomach. It dif- 
fuses into the blood with great facility, from the stomach, from the 
external integument, and from wounded surfaces. Cases of poison- 
ing have resulted from application to a patch of psoriasis (Toel), to 
scabies (Hoppe-Seyler, Machin), to the uterine cavity, after the enu- 
cleation of a fibroid (Rheinstadter), to abscesses (Kohler, Wallace, 
White), to the rectum for the relief of ascarides (Pinkham, Mi- 
chaelis), and to the integument and wounds, in cases of antiseptic 
surgery. Diffusion takes place with such rapidity, from these various 
sources, that formidable symptoms arise in a few minutes. The 
amount necessary to produce distinct effects varies ; besides the dif- 
ference due to age, there are variations in susceptibility. A one-per-cent 
solution has caused serious symptoms when injected into an abscess 
and into the rectum. Six drops of the pure acid have caused danger- 
ous symptoms, and a teaspoonful has terminated fatally, but one case 
is reported in which this amount was recovered from when taken by a 
child two and a half years old (Dessau). A tablespoonful has caused 
death in several instances (Cowling, Packer, and others). In Hoppe- 
Seyler's cases, while the two apprentices were rubbing each other's 
backs, both were seized suddenly with giddiness, vertigo, and tension 
of the head, and quickly passed into unconsciousness. These effects 
are also experienced when the poison is taken into the stomach. The 
warnings of danger, which may be expected when the remedy is 
brought in contact with the tissues at any point, are, besides the local 
irritation, sudden vertigo, contracted pupils, pallor of the face, em- 
barrassed respiration, and feeble circulation. When the dose is a fatal 
one, unconsciousness quickly supervenes, the breathing becomes ster- 
torous, the surface grows cold, the action of the heart gets more and 
more feeble, and death finally occurs from failure of respiration. Con- 
vulsions occur in animals, but in man this symptom is wanting, or at 
most fibrillary trembling, and some trismus of the jaws, are present. 

The changes in the blood induced by carbolic acid have been much 
disputed. That it enters the blood as carbolic acid seems positively 
established, although, having acid properties, it may become a carbolate. 
The acid has been discovered in the blood by Hoppe-Seyler. That it 
appropriates oxygen and thus undergoes some change in the blood is 
highly probable. Husemann maintains that the blood in carbolic-acid 
poisoning is very much altered in character, becoming dark in color 
and coagulating with difficulty, but in the reports of various post-mor- 
tem examinations it is remarked that the blood was coagulated in the 
heart and great venous trunks. Outside of the body the blood is 
quickly changed on the addition of carbolic acid, but these changes do 
not correspond to those which occur within the body. The action of 



CARBOLIC ACID. 325 

the heart is at first slowed, but toward the end it becomes rapid. The 
blood-pressure falls considerably below the normal, due, Hoppe-Seyler 
says, to vaso -motor paresis. The first slowing of the heart is caused 
by stimulation of the end-organs of the vagus, and is prevented by 
division of the trunk of the nerve. The subsequent rapid action is 
due to the removal of the inhibition from paralysis of the vagus. Res- 
piration is at first stimulated and the respiratory acts are more frequent, 
but they are also more shallow. Division of the pneumogastrics does 
not entirely prevent this stimulation, although it lessens the effect, 
whence it is concluded that carbolic acid also stimulates the respiratory 
center in the medulla (Salkowsky). This conclusion is strengthened 
by the fact that, if the vagi are previously divided, the administration 
of carbolic acid will still increase the respiratory acts for a time, show- 
ing that the stimulation of respiration must be effected by an action 
on the end-organs of the vagi in the lungs as well (Salkowsky). Low- 
ering of the temperature has been constantly observed in the experi- 
ments on animals, and in the cases of poisoning of man. The surface 
of the body is cool, and more or less livid. There are several factors 
concerned, doubtless, in the reduction of temperature. The diminu- 
tion in the blood-pressure and the arrested oxidation are the chief. 
The power of carbolic acid to reduce the temperature of fever is also 
clear, but in this respect it is inferior to salicylic acid (Eisenstein). In 
cases of poisoning the reduction of temperature reaches several de- 
grees, but in the normal condition in man ordinary medicinal doses 
have but little effect in this direction. 

A more or less minutely contracted pupil is a nearly constant phe- 
nomenon in carbolic-acid poisoning. It can hardly be doubtful that 
this effect is due to paralysis of the radiating fibers, leaving the cir- 
cular fibers unopposed. Carbolic acid unquestionably acts on the 
cerebral lobes — on the centers of conscious impressions — and suspends 
their functions. Vertigo and singing in the ears occur, and then con- 
sciousness is lost, the reflexes are suspended, and complete muscular 
resolution ensues. In warm-blooded animals clonic convulsions are 
produced, succeeded by paralysis. By direct application, as Bill was 
the first to demonstrate, carbolic acid suspends the irritability of the 
sensory nerves. If a tract of the integument be painted over with 
pure carbolic acid, an incision may be made into the part without the 
least pain being experienced. The peripheral nerves, sensory and mo- 
tor, are not affected by the systemic action. The muscles after poison- 
ing respond energetically to the usual forms of stimulation. It follows, 
then, that the action of the poison is centric and not peripheral (Sal- 
kowsky, Lemaire, Rothe). 

The elimination of carbolic acid takes place by various channels 
of excretion, chiefly by the urine. It may be detected by the odor in 
the breath of poisoned animals (Lemaire). It has been found in the 



326 ANTISEPTICS. 

saliva by Hoppe-Seyler, but Bill could not detect it in the perspiration 
or in the f aeces. Hoffmann maintains that carbolic acid undergoes oxi- 
dation in the blood, but, as a part of it may be separated unchanged 
from the urine, this statement is not wholly true. That much of the 
carbolic acid taken is oxidized before being excreted is proved by the 
character of a secondary product which appears in the urine. One of 
the earliest indications of the toxic action of carbolic acid, especially 
when applied locally, is a dark-greenish, blackish, or smoky hue of the 
urine. Although this appearance does not actually prove that danger 
to life is imminent, it is a warning to be heeded. One of the results 
of the oxidation of carbolic acid is the formation of oxalic acid. The 
same process takes place in animals, in whom carbolic acid is excreted 
as oxalic. Doubt has been thrown on the methods by which carbolic 
acid is detected in the urine of those taking it, through the experiments 
of Stadeler, who has discovered that carbolic acid is present in normal 
urine. Hoppe-Seyler, however, has proved that, by Stadeler's process* 
carbolic acid is made from the indican of the urine (Hermann). The 
elimination of carbolic acid taking place through so many channels is 
readily effected, and probably the whole amount is thrown out in 
twenty-four hours. When death occurs very quickly in fatal cases of 
poisoning, the tissues and organs will smell distinctly of the poison 
(Ogston). Death has occurred in a few minutes — in a great majority 
of the fatal cases within two hours (Jeffreys), and is rarely postponed 
to two days. The amount of carbolic acid present will therefore vary. 

There are no characteristic post-mortem appearances, except the 
changes wrought at the points of contact with the acid. The mucous 
membrane of the mouth, fauces, oesophagus, and stomach, where acted 
on, appears corrugated, tough, and discolored — whitish changing to 
brownish discoloration, surrounded by a zone of hyperemia, or capil- 
lary haemorrhages here and there sloughing off. Congestion of the 
viscera generally, especially of the brain and the meninges, is a con- 
stant phenomenon. The lungs are cedematous as well as congested. 
The heart may be distended with loose clots, and relaxed, or empty 
and contracted. By some observers changes akin to those of phos- 
phorus-poisoning have been uniformly discovered (Neumann), i. e., 
acute fatty degeneration of liver, heart, kidneys, and other organs, 
notably the renal epithelium. Husemann, Salkowsky, and others, 
deny the reality of these observations, so that further examinations 
are necessary to determine this point. 

Therapy. — Nausea and vomiting due to an irritable state of the 
stomach-nerves are relieved by carbolic acid. Combination with bis- 
muth enhances the effect. 1} Acidi carbolici, grs. iv ; bismuthi sub- 
nitrat., 3 ij; mucil. acacia?, § j; aquae menth. pip., 3 iij. M. Sig. : A 
taUespoonful every two, three, or four hours. Attacks of cholera mor- 
bus and cholera infantum are not unfrequently very promptly arrested 



CARBOLIC ACID. 327 

by the exhibition of carbolic acid, or the combination of carbolic acid 
and bismuth. Eructations of gas, due to the fermentation of foods, 
and the vomiting of yeast-like matters, especially when due to the 
presence of sarcina, are often arrested by this remedy. Good results 
have been obtained by the use of carbolic acid in Asiatic cholera. 
Combination with iodine is said to be more effective (Choleratropfen). 
$ Acidi carbolici, grs. iv ; tinct. iodi, gtt. xvj ; aquae menth. pip., 
3 iv. M. Sig. : A tablespoonful every hour, or oftener. The same 
formula has been used successfully in cholera nostras and cholera in- 
fantum (Rothe). 

Based on its power to arrest toe action of ferments, carbolic acid 
has been used, with certainly temporary good results, in diabetes of 
hepatic origin (Ebstein, Habershon). 

Inhalations of carbolic-acid spray possess a high degree of utility 
in chronic nasal catarrh, hay-asthma, chronic bronchitis, and whoop- 
ing-cough. A solution in water, to the proportion of one per cent, is 
a suitable solution for this purpose. It may be combined with the 
tincture of iodine. The efficacy of these inhalations in hay-asthma 
and in whooping-cough is probably due to the fact that carbolic acid 
destroys the minute organisms (cacobacteria, pollen), on the presence 
of which the morbid action in these maladies depends (Letzerich). The 
vapor of carbolate of iodine may be inhaled in these diseases. The 
warmth of the hand suffices to vaporize a mixture of carbolic acid and 
tincture of iodine. 

In pulmonary phthisis, when there is much teasing cough, or when 
expectoration is profuse and foul-smelling, these inhalations are ser- 
viceable. In gangrene of the lung, carbolic spray and the acid inter- 
nally are used to destroy the fetor. A one-per-cent solution of car- 
bolic acid and a mixture of carbolic acid and iodine have been injected 
with asserted advantage into phthisical cavities through the parietes 
of the thorax. 

Internally, also, creosote and carbolic acid, especially the former, 
have been used with conspicuously good results in the treatment of 
the several forms of consumption, except phthisis florida. Probably 
the most useful observations to illustrate this point are those of MM. 
Bouchard and Gimbert. They used pure creosote from wood, and in 
the following formula : Pure creosote, 13*5 parts ; tincture of gentian, 
30 parts ; alcohol, 250 parts, and sufficient Malaga wine to make up a 
thousand parts. Of this solution from two to five tablespoonfuls are 
taken daily. In other cases the creosote was given in cod-liver oil, 
which is an excellent vehicle — 2 parts of pure creosote to 150 parts of 
cod-liver oil. The daily quantity varied from six to nine grains, and 
in rare cases from twelve to fifteen grains. Of ninety-three cases of 
phthisis treated with this remedy, twenty-five were apparently cured, 
twenty-nine were improved, eighteen remained no better, and twenty- 



328 ANTISEPTICS. 

one died. Creosote thus had a good effect in fifty-four out of ninety- 
three cases. The evidences of improvement consisted in the diminution 
of the expectoration, cough, and fever, and increase in the appetite, 
strength, and weight of body. The diminution of the expectoration, 
and consequently of the cough, was the first evidence of improvement, 
although at the beginning of the treatment the cough is apt to be in- 
creased for a short time by creosote. If the cough and expectoration 
are constantly increased, the medicine must be stopped. The danger 
of haemoptysis is rather lessened than increased by the creosote treat- 
ment. Schnitzler, of Vienna, has employed, recently, the subcutane- 
ous injection of carbolic acid in more than one hundred cases of con- 
sumption. He practiced the injections daily, sometimes twice a day, 
administering each time from one eighth to one fourth of a grain. 
The result was, in most cases, the fever was reduced, the pulse became 
slower and stronger, and the night-sweats were diminished. He con- 
cludes that these injections are nearly if not quite as effective in re- 
lieving hectic as quinine. 

Influenced by the germ theory of disease, carbolic acid has been 
much prescribed in the treatment of typhoid fever, diphtheria, scarlet 
fever, erysipelas, etc. Whether the theory be true or false, there can 
be no doubt of the good effects of creosote and of carbolic acid in 
these diseases. Pecholier, of Montpellier, has given creosote in sixty 
cases of typhoid, set apart for study of the results of the action. 
Good effects were obtained ; the temperature kept down ; the delir- 
ium and insomnia were much less ; the intestinal disturbance declined, 
and thus the violence of the disease was distinctly lessened. M. Cha- 
pelle maintains that it cuts short an attack of typhoid. In the other 
maladies above named, the evidence of the good effects of carbolic 
acid is constantly accumulating. Besides the internal administration, 
local application to the fauces of spray, or suitable solutions, are use- 
ful in diphtheria and scarlet fever to remove fetor, and to destroy the 
germs of contagion which may be lodged there. Recently Rothe has 
treated a number of cases of typhoid fever, with great success, by a 
mixed antiseptic and antipyretic method, in which he employs carbolic 
acid and iodine administered in infusion of digitalis. The author has 
for several years treated the cases of typhoid and typho-malarial fever 
so called, which have been in his hands, with a drop each of tincture 
of iodine and liquefied carbolic acid every two or three hours, with 
results which were certainly most favorable. As Rothe has observed, 
this antiseptic treatment lowers the heat, lessens the diarrhoea, im- 
proves the mental state, and, indeed, diminishes the severity of the 
disease remarkably. The value of carbolic acid as a remedy in mala- 
rial fevers seems now conclusively established. The experiences of 
Eisenstein in the Vienna General Hospital are especially valuable. 
He obtained distinct curative effects in twenty-four cases of the tertian 



CARBOLIC ACID. 329 

and in four cases of the quotidian type of intermittents. The author 
has found the combination of carbolic acid and iodine of great value 
in chronic malarial infection, and in the more acute cases after quinine 
has stopped the paroxysms. As an antipyretic, Eisenstein justly re- 
gards carbolic acid as inferior to salicylic. It is probable that resor- 
cin, hydroquinone, and other phenols, will prove more useful than either. 
Dr. Lecaille has found carbolic acid remarkably efficacious in yelloio 
fever, and even after the occurrence of the ominous " coffee-grounds " 
vomit. He administers it both subcutaneously and by the stomach. 

The dose of carbolic acid for internal use ranges from half a grain 
to two grains, or of the liquefied acid from half a minim to two min- 
ims. It may be given in mint-water, which covers the odor some- 
what. This quantity may be repeated every hour or two, if necessary, 
without producing ill effects, if not too long continued. As mentioned 
above, the quantity given by Bouchard and Gimbert sometimes 
reached as high as fifteen grains a day. The mixture of bismuth, 
mucilage, and glycerin, is an excellent vehicle. When iodine and 
carbolic acid are given together, a colorless carbolate is formed when 
they are dropped into water. 

Parenchymatous Injection of Carbolic Acid. — The deep-seated 
injection of carbolic acid has been proposed and successfully practiced 
for the relief of various morbid states. For this purpose a two-per- 
cent solution is most suitable. A solution stronger than this may 
excite inflammation in the part and coagulate the blood. It is di- 
rected by Htiter that the needle of the hypodermatic syringe be first 
inserted into the inflamed part, and, if no blood flows out through the 
needle, it will be known that a vein has not been penetrated. From 
twenty to thirty minims of the solution are then injected. The in- 
jections are made once or twice a day in acute diseases, and on alter- 
nate days, or less frequently, in chronic cases. Very remarkable results 
have been obtained from these injections in erysipelas (Htiter, Auf- 
recht) and in pleuro-pneumonia (Kunze). 

Dr. Tessier, of the Mauritius, reports that i?itermittents are rapidly 
cured by the injection of three quarters of a grain of carbolic acid dis- 
solved in twenty minims of water. 

The parenchymatous injection of carbolic acid is more especially 
adapted to the treatment of certain surgical maladies. Htiter has 
employed this method successfully in lupus, chancroid, secondary 
syphilitic abscesses, ulcerations, synovitis (injected into the affected 
joint), fistulm, enlarged bursal, hydrocele, etc. Levis, of Philadelphia, 
cures hydrocele h j injecting liquid carbolic acid into the sac after 
drawing off the fluid. He first inserts the needle of the syringe so 
that it may be certain the point rests in the cavity. Then the fluid is 
drawn off, and finally the acid, a drachm or two, is injected through 
the needle. 



330 ANTISEPTICS. 

Local Application of CaPwBolic Acid. — Itching of the shin, aris- 
ing from any cause, is allayed by sponging the part with a solution of 
carbolic acid. $ Acid, carbol., 3 ij ; glycerini, 3 j ; aqua rosse ad 
§ viij. M. Sig. : Lotion. This application is especially serviceable 
in prurigo and prurigo sinalis. Carbolic acid is an effective applica- 
tion in parasitic skin-diseases — pityriasis versicolor, tinea tonsurans, 
tinea circinata, favus, scabies, etc. t> Acid, carbol., 3 j ; glycerini, 
§ j. M. Sig. : Local application for parasitic skin-diseases. The in- 
ternal administration of carbolic acid should be conjoined with its local 
use in prurigo, chronic eczema, and sycosis parasitica. 

The following is an efficient local application for chilblains: 5 
Acid, carbol., 3 j ; tinct. iodi, 3 ij ; acid, tannici, 3 ij ; cerat. simpli- 
cis, ^ iv. M. Sig. : Ointment. 

Undiluted carbolic acid is used as a mild escharotic to the so-called 
mucous patches, to condylomata, vegetations, etc., lupus, scirrhus, cau- 
liflower-growths, etc. The author has witnessed results which appear 
to him to justify the statement that carbolic acid, applied undiluted 
to the cancerous sore and injected underneath, limits the extension 
and retards the growth of the disease. In several cases, the disease 
having recurred at the site of the operation for its removal, the author 
has apparently arrested the morbid process by injecting beneath and 
into the new formation daily a syringeful of a five-per-cent solution 
of carbolic acid. The action in these instances seemed to be local : 
there were none of the evidences of systemic impression of the poison, 
and no diffusion of the cancer-germs took place from the point of in- 
fection. If further experience confirms these observations, we have in 
this method a most important contribution to our resources. 

Undiluted carbolic acid is an efficient application to xdcers of the 
cervix uteri, chronic endo-cervicitis, and endo-metritis. It may be ap- 
plied undiluted without risk to the mucous membrane of the uterine 
cavity, on the cotton-wrapped probe, after preliminary dilatation of 
the canal. There is, probably, no better means of treating uterine 
catarrh. 

Solutions of carbolic acid, of average strength, have the power to 
check suppuration, and to correct the fetor of sloughing and ill-condi- 
tioned wounds. The methods of Mr. Lister's antiseptic treatment in- 
clude a much more extended application of carbolic acid. Embrac- 
ing the fermentation theory of M. Pasteur, Mr. Lister holds to the 
necessity of excluding germs from contact with wounded surfaces. 
Operations by the method of Mr. Lister must be performed under and 
in a spray of carbolic acid (one part to forty). The solution may be 
pulverized by the ordinary hand-ball atomizer, or better by a Siegle's 
steam atomizer. All knives, sponges, and ligatures must be " car- 
bolized " before coming into contact with the wounded surface. The 
antiseptic dressing is thus described by Mr. Lister : " It consists of 



CARBOLIC ACID. 331 

two pieces of folded gauze and mackintosh (fine cotton cloth with a 
layer of caoutchouc), an anterior and a posterior one. The wound is 
covered with several thicknesses of gauze dipped in a solution of car- 
bolic acid (one to forty), and over this is placed the folded gauze and 
mackintosh, of sufficient size to extend beyond the margins of the 
wound in all directions." The dressing is confined by turns of a 
" gauze bandage," and is allowed to remain undisturbed for from two 
days to a week, " the general rule being that the dressing should be 
changed on any day on which the discharge is observed to have ex- 
tended beyond the edge of the folded gauze." 

Antiseptic gauze consists of cotton cloth charged with the follow- 
ing : " One part of crystallized carbolic acid, five parts of common res- 
in, and seven parts of solid paraffin " — the paraffin and resin are first 
melted together, and the acid is then incorporated by stirring. A very 
complicated process, too elaborate for insertion here, is described by 
Mr. Lister, for diffusing the above-described mixture equably through 
the cotton cloth. For lubricating instruments, especially catheters 
and bougies, he advises a solution of one part of carbolic acid in 
twenty parts of olive-oil. Carbolized silk sutures are "prepared by 
immersing a reel of the silk in melted beeswax, mixed with about a 
tenth part of carbolic acid, and drawing the thread through a dry 
cloth as it leaves the liquid, to remove superfluous wax." 

The following is the University College formula for the prepara- 
tion of carbolic-acid plaster : " Shellac, 75 ; carbolic acid, 25. Melt 
the shellac with 8 of the acid, and then add the remaining 17, and mix 
thoroughly. The mixture should be spread on linen, and should be 
coated with a solution of gutta-percha in bisulphide of carbon." 

The admirable results in the treatment of wounds obtained by Lis- 
ter have been fully confirmed by various competent observers (Nuss- 
baum, Thiersch, Yolkmann, Bardeleben), and, although objectors have 
risen to deny the superiority of the method, it has been shown that 
the ill-success complained of was due to inattention to the various de- 
tails necessary. 

Toxic Symptoms induced by Carbolic Acid when used ex- 
ternally. — The extraordinary extent to which carbolic acid is now 
applied in surgical practice renders it necessary to devote some atten- 
tion to the symptoms indicating a dangerous degree of absorption. 
This form of poisoning occurs under two forms : one, sudden, the 
patient sinking into collapse immediately after the dressings are ap- 
plied ; the other, occurring insidiously, after some weeks of treatment 
and applications of the antiseptic dressings. Kuster, of Berlin, relates 
five cases of the first form, in which the patients, after the dressings 
were applied, sank at once into a condition of collapse like the state of 
shock from a most formidable surgical operation. Only one of these 
cases recovered. The diagnosis of this toxic state from surgical shock 



332 ANTISEPTICS. 

will be referred to presently. In the other form of poisoning the 
symptoms appear gradually, and are apt to be attributed to a com- 
mencing septicaemia. Loss of appetite, nausea, feverishness, head- 
ache, vertigo, and clonic spasms, are first experienced, prostration sets 
in, and a more or less profoundly comatose state develops. The onset 
of these symptoms, or the depression which initiates the morbid phe- 
nomena in the first form, occurs at a time when more favorable symp- 
toms are properly expected. But the diagnosis is arrived at readily 
by an examination of the urine. The change in the color and the 
peculiar odor of the urine observed in carbolic-acid poisoning have 
been referred to, but the chemical tests are more important. Accord- 
ing to Baumann, we have, in Sonnenberg's test, the best means of de- 
termining the presence of carbolic acid. This test depends on the fact 
that any carbolic acid in the urine unites with the sulphates to form 
the sulphocarbolates, and hence it consists in determining the amount 
of normal sulphates present. The urine is first acidulated with strong 
acetic acid, and baric chloride is then added in excess. A copious 
precipitate, consisting, for the most part, of baric sulphate, is formed, if 
the urine is healthy ; but if it contain carbolic acid, scarcely any pre- 
cipitate will be thrown down, because of the formation of soluble sul- 
phocarbolates. The researches of Baumann have furnished us with an 
antidote of a chemical kind, which may be applied if there is time. 
He has shown that sodic sulphide forms in the body, with carbolic 
acid, the innocuous sulphocarbolate, and hence a soluble sulphate, as 
Glauber's salts, will be a proper antidote. As, however, the toxic ac- 
tion of carbolic acid is very speedy, the chemical antidote may not 
have time. Under these circumstances it will be found, probably, 
that the physiological antagonist is more speedy and effective. Atro- 
pine is apparently a most certain antagonist. It has succeeded in some 
very unpromising cases, and in my experiments on animals the results 
have been most favorable to the existence of the antagonism. 

Carbolic acid enters into the composition of Morrell's antiseptic 
fluid, which is used as a disinfectant for general purposes, and for the 
preservation of bodies. The following is the formula : " Dissolve 13"5 
parts of arsenious acid and 6 '9 parts of sodic hydrate in 15 to 20 parts 
of water ; add enough carbolic acid until the clear fluid, after stirring, 
appears turbid (that is, until the liquid is fully saturated with carbolic 
acid), and dilute with water to make 100 parts." 

Sulphocakbolates. — Soclii Sulphocarbolas. Sulphocarbolate of 
sodium. 

Potassii Sulphocarbolas ; Calcii Sulphocarbolas ; Magnesii Sul- 
phocarbolas. 

Of these salts, the first-named is the most important, and is the 
only one official. The first step in the formation of these salts consists 
in the production of sulphocarbolic acid, obtained by dissolving one 



CARBOLIC ACID. 333 

part of crystallized carbolic acid in an equal weight of strong sulphu- 
ric acid. The next step consists in the formation of sulphocarbolate 
of barium, from which the other salts are obtained by double decom- 
position. 

Sulphocarbolate of sodium occurs in transparent rhombic prisms, 
which are permanent in the air, dissolve in about five parts of water, 
and are also soluble in glycerin and alcohol. Most of the sulphocar- 
bolates have a faint pinkish tint, and are, like the soda-salts, soluble in 
water, alcohol, and glycerin. The dose for internal administration 
ranges from ten to thirty grains. Saturated or weaker solutions may 
be employed topically. 

These preparations, devised by Dr. Sansom, were intended to secure 
the antiseptic and antipyretic action of carbolic acid without any of 
the caustic and depressing action of the latter. In such septic diseases 
as diphtheria, the eruptive fevers, puerperal fever, they may be used 
freely. There seems little ground for the assumption that the carbolic 
acid is freed from its associates in passing through the organism, for 
-the sulphocarbolates do not have the effects of carbolic acid, and the 
urine does not have the greenish, blackish, or smoky hue characteristic 
of the latter remedy. There can be little doubt that the sulphocar- 
bolates are excellent topical applications to the inflamed mucous mem- 
brane, wherever accessible. The author has had good results from 
their use in acute inflammation of the fauces, in tonsillitis, in catarrh 
of the nares, in otorrhoea, and also in gonorrhoea. These salts are 
useful as deodorant and antiseptic applications to unhealthy wounds 
and ulcerated surfaces, to aphthae in children, etc. Although the 
sulphocarbolate of sodium has been added to the new pharmacopoeia 
list, it must be admitted that the sulphocarbolates do not maintain the 
position to which they were first introduced. 

Authorities referred to : 

ArFRECHT, Dr. E. Schmidt's Jahrbiicher, vol. clxiv, p. 147. 
Bill, Dr. J. H. American Journal of Medical Sciences, October, 1870. 
Declat, Dr. G. Nouvelles Applications deVAcide Phenique, etc., Paris, 1865. 
Eisenstein, Dr. Von Bitter. Wiener Med. Presse, No. 35, 1878. 
Gimbert et Bouchard. Gaz. Hebdom., Nos. 31, 33, 1877. 
Grote, Dr. C. H. Diss. Berolini. Die Carbolsdure in der Medicin. 
Habershon, Dr. S. 0. Guy's Hospital Reports, vol. xv, 1869-'70, p. 530. 
Hoppe-Seyler, F. Schmidt's Jahrbiicher, vol. civ, p. 273. 
Husemann, Dr. Theod. Deut. Klinih, 1870 and 1871. 
Hueter, Dr. C. Schmidt's Jahrbiicher, vol. clxiv, p. 144. 

Kohler, Dr. H. Handbuch der physiologischen Therapeutik, 1876, p. 1206, et seq. 
Kunze, Dr. C. F. Schmidt's Jahrbiicher, vol. clxiv, p. 147. 
Lemaire, Dr. Jules. De VAcide Phenique, Paris, 1863, p. 754. 
Letzerich, Dr. Lctdwig. Virchow's Archiv, Band lx, p. 409. 
Ibidem. Band lvii, p. 518. 
Lister, Dr. Joseph. Tlie Lancet, vol. i, 1875. 
Ibidem. The British Medical Journal, vol. ii, 1875, p. 769. 



334 ANTISEPTICS. 

Neumann, Dr. Isidor. Schmidt's Jahrbucher, vol. cliii, p. 141. 
Kothe, Dr. C. Gr. Die Carbolsaure in der 3/edicin, Berlin, 1875, p. 63. 
Salkowsky, Dr. Schmidt's Jahrbucher, vol. civ, p. 272. 
Taylor, Dr. W. E. Philadelphia Medical Times, vol. ii, p. 284. 
Taylor, Dr. A. S. On Poisons, third edition, 1875, p. 243. 

Salix. — Salix. The bark of Salix alba Linne, and of other species 
of Salix (Nat. Ord. Salicaceoe). 

Salicinum. — Salicin. A neutral principle obtained from the bark 
of Salix helix Linne, and of other species of Salix. Colorless, white, 
silky, shining crystals, permanent in the air, odorless, having a very 
bitter taste and a neutral reaction. Soluble in 28 parts of water, and 
in 30 parts of alcohol at 59° Fahr. ; insoluble in ether or chloroform. 
(U. S. P.) Dose, 3] — 3 ij. So little soluble, it were better admin- 
istered in a wafer, powder, or emulsion. 

Actions and Uses. — Salicin promotes appetite and the digestion — 
properties which it possesses in common with other bitters. It is an 
antiferment, and has antiseptic powers similar to quinine and salicylic 
acid. The latter is a derivative of salicin. It is destructive to bac- 
teria and vibrio, and prevents the reaction of amygdalin and emulsin, 
and of ptyalin on starch. It does not produce very sensible effects 
even in large doses, and is without toxic activity. It has been used 
as a substitute for quinine in the cases of disease to the treatment of 
which the latter is applied, especially in the treatment of intermittents. 
It is, however, much inferior to quinine. 

Salicin is an excellent stomachic tonic in atonic dyspepsia, and is a 
serviceable remedy to prevent the fermentations which take place in 
the foods in cases of g astro-intestinal catarrh. In the chronic diar- 
rhoea of children, it has been employed successfully. The good results 
obtained from it in these cases are doubtless due to its antiferment 
properties and its lack of irritating qualities. 

The most important use of salicin thus far proposed, is in the treat- 
ment of acute rheumatism — information which we owe to Dr. Mac- 
lagan. He concludes, as the result of his experience, that the more 
acute the case the more beneficial the remedy ; that the good effects 
are always experienced within forty-eight hours ; that, sometimes, the 
disease is at once arrested ; that relief of pain and fall of temperature 
are the earliest effects produced. Maclagan gives from ten to thirty 
grains every two, three, or four hours, in powder mixed with water. 
" Fifteen grains every three hours is a medium dose." 

Much confirmatory evidence has been published ; but, on the whole, 
salicin is generally regarded as inferior to salicylic acid. There are 
conditions of the system, however, in which salicin should be pre- 
ferred to any of its congeners. In those cases characterized by weak 
heart, whether from adherent pericardium, myocarditis, fatty degen- 
eration, or other causes, salicylic acid may be dangerous. Again, 



SALICYLIC ACID. 335 

when the vaso-motor system is depressed, salicin is far safer. As the 
curative results obtained from salicin are but little inferior to those 
from salicylic acid, whenever the latter is contraindicated, the former 
may be confidently relied on, if efficiently administered. 

Authorities referred to : 

Husemann, Drs. Aug. und Theod. PJlanzenstoffe, p. 959, et seq. 
Maclagan, Dr. T. The Treatment of Acute Rheumatism by Salicin. The Lancet, 
March, 1876. 

Acidum Salicylicum. — Salicylic acid. Acide salicylique, Fr. ; Sali- 
cylsdure, Ger. 

Properties. — Salicylic acid crystallizes in needle-shaped crystals, 
which are soluble in alcohol and ether, and in hot but not in cold 
water. It is without smell, and its taste is slight and not disagree- 
able. The solubility of salicylic acid in cold water is increased by the 
presence of neutral salts. Three parts of phosphate of sodium will 
render one part of the acid easily soluble in fifty parts of water. Bo- 
rate of sodium is still more efficient in promoting the solubility of the 
acid, and, as boracic acid has properties corresponding to salicylic, the 
borate should be preferred for this purpose. It has been shown that 
ten parts of salicylic acid can be dissolved in one hundred parts of 
water, by the addition of eight parts of borax (Bose). The borax 
should be first dissolved by the aid of heat, and the salicylic acid 
should be added gradually to the hot solution of borax. On cooling, 
filtration is necessary to separate a small quantity of undissolved 
residue. 

The dose of salicylic acid for internal administration ranges from 
ten grains to one drachm. 

Sodii Salicylas. — Salicylate of sodium. Dose, grs. xv — 3 j. The 
best mode of administration is in the form of wafer, containing five 
to ten grains. These may be given rapidly until the requisite quan- 
tity has been swallowed. Salicylate of soda may be prepared extem- 
poraneously by the addition of salicylic acid to a solution of bicarbonate 
of sodium. If the alkali is in excess, the resulting solution is brown- 
ish or purplish in color, and has a strong odor of wintergreen. This 
is not repulsive to most patients. 

The following is a suitable formula : ~fy Acidi salicylici, 3 ij ; sodii 
bicarb., 3 j ; aquae, § ij. M. Sig. : A teaspoonful every two, three, or 
four hours. 

Antagonists and Incompatibles. — The mineral acids, the me- 
tallic salts, and the preparations of iron in general, are chemically in- 
compatible. From the physiological standpoint, salicylic acid and 
the salicylate of soda are antagonized by the arterial and cerebral 
stimulants. 

Synergists. — The effects of salicylic acid are increased in all di- 



336 ANTISEPTICS. 

rections by the members of the phenol group, by the arterial depres- 
sants, and by the anaesthetics and cerebral sedatives. 

Physiological Actions. — In small doses, salicylic acid may stimu- 
late digestion, but in considerable quantity, especially if frequently 
repeated, it causes uneasiness at the epigastrium, nausea, and vomit- 
ing. This inability of the stomach to dispose of the large doses of 
salicin, salicylic acid, and salicylate of soda, required in the treatment 
of certain diseases, is an obstacle to their use. They are diffusible and 
readily enter the blood. It is in a high degree probable that salicylic 
acid combines with an alkaline base and enters the blood as a salicyl- 
ate — as a salicylate of sodium, according to Salkowsky. Binz holds 
that the free carbonic acid present in the blood must effect the separa- 
tion of salicylic acid from its combinations, and hence that salicylate 
of soda must act as salicylic acid. It is well known, of course, that 
salicylate of soda does not possess the antiseptic property of salicylic 
acid, and, as both act similarly after their medicinal administration, it 
seems highly probable that the decomposition just mentioned does 
actually take place. An observation of Kohler seems to support the 
theory of Binz. Kohler found that, while ordinary blood containing 
salicylic acid did not yield it up to ether, the blood of asphyxia, which 
contains an exceptional quantity of carbonic acid, did yield up its 
contained salicylic acid to ether. The blood in the vessels unques- 
tionably contains more carbonic acid than that which has been exposed 
to the air. Salicin, as Senator first demonstrated, under the action of 
ferments, splits up into saligerine and glucose, and saligerine is readily 
oxidized into salicylic acid. This process is supposed to occur in the 
body, and hence the comparative slowness of action of salicin and 
similarity in its effects to salicylic acid. Spencer, examining the blood 
of a person taking salicin, only got evidence of the presence of the 
glucoside but not of the salicylic acid, and in the urine of the same 
subject found but a small part of the acid which ought to have ap- 
peared, whence he concludes that the conversion of salicin into sali- 
cylic and salicyluric acids, according to Senator, is but partially accom- 
plished in the organism. These observations adequately explain the 
superior activity of salicylic acid as compared with salicin. 

In health, ordinary doses of salicylic acid and salicylate of sodium 
have but little effect on the circulation. In the carefully conducted 
experiments of Ringer and Morshead, made on normal subjects, con- 
siderable doses of the acid increased the pulse-rate from ten to twenty 
beats, but more or less feverishness was produced by the irritant ac- 
tion on the gastro-intestinal mucous membrane. The manometric 
studies of Kohler demonstrated that this agent lowers the blood-press- 
ure, and this result occurred after division of the vagi, the depressors, 
and the spinal cord, whence it must be concluded that it accomplishes 
this result by a direct action on the heart and vaso-motor ganglia. 



SALICYLIC ACID. 337 

More recent observations by Oltramare show that when salicylic acid 
is thrown into the veins the first effect is to increase the energy of the 
systolic contractions, the number of pulsations, and the blood-pressure. 
These effects, he finds, are due to a direct stimulation of the heart and 
of the motor centers. Under the influence of increasing doses, the 
vessels dilate, the blood-pressure falls, and finally the heart is arrested. 
There is, therefore, a general agreement as to the increase of the ac- 
tion, lowering of the blood-pressure, etc., as studied in animals, and 
observed on man by Ringer and Morshead. Professor See, however, 
fails to discover any effect by salicylic acid on the heart or blood- 
pressure, but, as he administered the remedy by the stomach, it is 
probable that he did not secure admission to the blood of a sufficient 
amount. 

The numerous observations made on the effect of salicylic acid and 
salicylates on the heat-function are in close accord. In health it is 
found that, unless toxic doses are taken, the tenrperature is but slightly 
or not at all affected. Riess, one of the first to make observations on 
this point, noted a constant reduction of the normal temperature ; but 
See, Ringer, Fiirbringer, and others, agree that in health this agent 
does not affect the temperature. Riess's conclusions were based on 
more than four hundred observations of the internal use of salicylic 
acid, and in twenty-three cases he ascertained a reduction of 1'6° 
Fahr., produced by five grammes (nearly eighty grains). If fever is 
present, whether produced artificially by the injection of septic ma- 
terials, or arising spontaneously, salicylic acid very uniformly effects 
a considerable redaction. The result, however, is not always the same. 
That salicylic acid has a decided antipyretic action is denied by Zim- 
mermann, Wolff berg, and some others ; but the weight of testimony 
is overwhelmingly the other way. It is certain that the degree of 
antipyretic effect varies in different forms of fever (Bartels, Senator, 
Nathan, and others), and also according to the individual susceptibility 
to its action. The phenomena attending the reduction of temperature 
are worthy of consideration. At the onset of the action, in ten to 
fifteen minutes after the dose is swallowed, some increase in the heart's 
action, a feeling of warmth through the system, and flushing of the 
face with suffusion of the eyes are experienced, then the perspiration 
begins, appearing first on the face, then on the chest, abdomen, and 
extremities, and presently becomes profuse. Coincidently with the 
sweat, the decline in temperature begins, but it continues after the 
sweating. There is no ratio between the amount of sweating and the 
reduction of fever-heat, for with much sweating there may be but 
slight diminution in the temperature, and with little sweating a marked 
decline. In febrile cases the decline of temperature varies from 1° to 
6° Fahr. (Riess, Nathan, Bartels, Ewald, and others). The quantity 
of salicylic acid necessary to effect any considerable reduction of tem- 
22 



338 ANTISEPTICS. 

perature ranges from one to two drachms. The effect is maintained 
from five to twenty hours, when a repetition of the dose usually be- 
comes necessary. With the first effect of the agent on the heart, the 
pulse rises, but, as the sweating progresses, more or less slowing of the 
heart-beat occurs. There are differences of opinion, however, on this 
point. Thus, Ewald, Riess, Goltdammer, and a few others, hold that 
the pulse is little if at all affected ; but the usual expression is that, 
after a preliminary rise, there ensues with the perspiration and lower- 
ing of the temperature a marked decline in the pulse-rate (Buss, Star- 
gard, Nathan, Moeli, etc.). 

With the first impression of this agent on the respiratory center, 
the number of respirations is increased, but, with the decline of tem- 
perature and of the pulse, they are lessened. The excretion of car- 
bonic acid, Livon shows, is the greater, the larger the dose of salicylic 
acid, estimated during the period of increased action of the lungs. 
Under the influence of large doses, accumulation of the acid takes 
place in the cerebro-spinal fluid, causing an excitation of the roots of 
the pneumogastric nerve, but the excitation is succeeded by the de- 
pression which terminates in arrest of the respiratory function. 

As the effects of salicylic acid or salicylate of sodium develop, more 
or less headache, with a feeling of distention and frontal oppression, is 
experienced. Buzzing in the ears, dullness of hearing, and even deaf- 
ness, are usual symptoms when the doses are large. Vision is also 
affected, the sight becoming dim, or strabismus or ptosis occurs. In 
one case sudden and complete amaurosis came on (Gatti) after the ad- 
ministration of one hundred and twenty-five grains of salicylate of 
soda ; the pupils were widely dilated, the sclerotic and cornea acquired 
extreme sensibility, but the retina was unchanged, and the vision for- 
tunately was restored after ten hours without impairment. In other 
cases, subacute delirium, or delirium with refusal of food, and various 
delusions (Daly) have occurred while patients were taking consider- 
able doses. Ordinarily, however, the cerebral effects of salicylic acid 
are not unlike those of quinine. The state of the intracranial circula- 
tion which it induces has not been studied. According to Blanchier 
and Rochefontaine, salicylate of soda depresses the functions of the 
central nervous system, but the irritability of both sensory and motor 
nerves and the contractility of muscle remain unimpaired. 

Animals to whom salicylate of sodium is administered daily for 
some time, emaciate rapidly (Chirone and Petrucci). The toxic dose 
for the dog, ass, and horse, according to Oltramare, is one gramme 
per kilogramme of the body- weight. Death is due to paralysis of the 
heart, and not from asphyxia, as has been heretofore supposed (Oltra- 
mare). After death the abdominal viscera are intensely congested, 
unless the medulla be divided, when a marked degree of anaemia suc- 
ceeds to the hyperemia. It is this fact chiefly which induces Oltra- 



SALICYLIC ACID. 339 

mare to maintain that salicylate of sodium acts on the vaso-motor 
center in the medulla. 

On man as well as on animals sometimes salicylic acid produces se- 
rious symptoms. The intoxication, with delirium and delusions which 
it causes in certain subjects, especially those suffering from acute rheu- 
matism, has been referred to. In drunkards it is especially apt to act 
unfavorably, bringing on in them violent delirium. In rare instances 
salicylic acid and the salicylates have induced a condition of collapse, 
with restlessness, delirium, great dyspnoea, feeble pulse, and involun- 
tary evacuations. The vaso-motor paresis, which is a result of large 
doses in feeble subjects, may be accompanied by great relaxation of 
the skin, the rapid formation of bed-sores, etc. Dr. Tuckwell, of the 
Radcliffe Infirmary, Oxford, gives the following symptoms as occur- 
ring in two cases under his observation : " Loud, deep, and sighing res- 
piration ; a strange restlessness, gradually increasing to delirium, and 
not unlike that of delirium tremens, with involuntary evacuation of 
urine and faeces in the worst of the two cases ; a slow and laboring 
pulse ; an olive-green color of the urine." No fatal case, distinctly 
due to these preparations, has been reported, but many have occurred 
in which very dangerous symptoms arose ; but, fortunately, all dis- 
appeared on stopping the administration of the remedy. The existence 
of albuminuria is an important factor in the causation of bad results 
(Huber). 

The rate of diffusion of salicylic acid has been closely studied by 
Blanchier and Rochefontaine, with the following results : When in- 
jected into the veins of a dog, salicylate of soda appeared in the saliva 
in four to five minutes ; in the urine, eight to ten minutes ; and in the 
bile and pancreatic secretion, in fifteen to twenty minutes. When 
taken into the stomach, it appeared in the saliva in twenty minutes, 
and in the urine in forty-five minutes. In man salicylic acid is ex- 
creted chiefly, almost wholly, by the kidneys, and appears in the urine 
in twenty minutes after it is taken into the stomach. It is excreted 
as salicyluric acid, which may be seen as a deposit at the bottom of 
the vessel, "of a white, feathery consistence." The urine presents a 
more or less deep greenish tint. The presence of the acid is readily 
ascertained by the solution of chloride-of-iron test. To the urine sus- 
pected to contain salicylic acid, add slowly, drop by drop, the chloride- 
of-iron solution ; phosphate of iron is first formed, which is whitish in 
color, but presently, if salicylic acid be present in a free state, a violet 
color is developed. The urine, during a course of the acid or of the 
salicylates, frequently contains albumen, due, doubtless, to the irrita- 
tion of the kidneys as elimination is going on. The facts do not yet 
warrant any conclusion in regard to the damage which may be perma- 
nently inflicted on the kidneys by the prolonged administration of this 
agent. The influence over the urinary excretion has been examined 



340 ANTISEPTICS. 

by Bouchard. There is reason for believing that the urinary water 
is not augmented, the extractives are somewhat increased, and the 
phosphates and coloring-matter are unchanged. Prof. See finds that 
the excretion of uric acid in gouty cases is promoted. It is main- 
tained by others that the amount of urea present in the urine is greater 
than normal. Livon and J. Bernard have ascertained that salicylic 
acid, after being thrown into the stomach or into a vein, appears with- 
in an hour or two in the saliva, milk, pancreatic secretion, bile, as well 
as urine, and it was always found in the cerebrospinal fluid. They 
conclude that it acts locally at these points of contact with the struc- 
ture of organs. Hence, it appears highly probable that the local stimu- 
lation increases the product of those glands through which the acid 
or its salt passes, but not in the urine, if Bouchard's observations can 
be relied upon. Albuminuria, according to Gubler, is produced by it 
in some cases, and temporary impotence has been observed in others. 

Therapy. — The applications of salicylic acid in the treatment of 
disease are based on the results of the physiological examination. In 
the diseases of the stomach characterized by fermentative changes in 
the food, as in catarrh, dilatation of the organ, etc., salicylic acid is 
an effective remedy. The author has seen admirable results from its 
use in gastralgia, even when distinctly periodical. In the vomiting 
of a pasty, fermenting mass of ingesta, whether or not accompanied 
by the organism, sarcina, or other germs of fermentation, good results 
are derived from this remedy. In these stomachal disorders, the best 
effects are had from ordinary doses (five to ten grains), given in a 
wafer, either in anticipation of the attack — as of gastralgia appearing 
at a fixed hour — or during the process of fermentation in the stomach 
contents. As a portion of the remedy taken passes into the faeces, it 
is probable that salicylic acid is just as effective in the corresponding 
troubles in the intestines. Ilgin reports the removal of tmnia solium 
in six cases by the administration of salicylic acid, in eight-grain doses 
every hour until five doses were taken — preceding and following the 
acid with a dose of castor-oil. It has been employed successfully in 
the removal of ascarides, by local application and by internal adminis- 
tration. An enema of water should precede the salicylic-acid solution, 
which may be composed of borax and salicylic acid with some gly- 
cerin. I> Acid, salicylic, 3 ss ; sodii biborat., 3 ss ; aquse, Oj. M. 
Sig. : Warm, and administer the whole amount at one time. For a 
young child, this quantity should be reduced one half, or more. 

When the heart is weakened from any cause, salicylic acid and 
salicylate of soda must be exhibited with caution. The experience 
thus far accumulated warrants the assertion that the dose of fifteen 
grains of the former and twenty of the latter should rarely be ex- 
ceeded, if frequent repetition of the dose is practiced. From Riess, 
who regards salicylate of soda as a specific in typhoid fever, to Filatow, 



SALICYLIC ACID. 341 

who holds that it is worse than useless, there are various shades of 
opinion, with the weight of authority decidedly in favor of the view 
that it is a remedy of real value. Since Riess, no one has claimed in 
this remedy a specific for typhoid, but it is generally admitted that it 
renders the course of the disease milder by keeping the temperature 
within safe limits (Tomkins, Hallopeau, Butt, Immermann, Senator, 
etc.). Weiss concludes, after an experience of ninety-six cases of ty- 
phoid in children, treated with salicylate of soda, that it is a powerful 
antipyretic in the typhoid of children, and that, while it does not 
shorten the course of the disease, it renders it much milder. He finds 
that the results are better, when the typhoid of children is treated by 
salicylate of soda, than have hitherto been obtained from quinine and 
cold baths. A still more recent English experience is to the same pur- 
port as the German. Dr. Tomkins finds that in the salicylates we 
have the means of reducing fever-heat, more certain and more agree- 
able than by the cold bath. In the eruptive fevers, the same prin- 
ciples obtain as in typhoid. Salicylate of soda is preferable to sali- 
cylic acid, because it is less irritating, safer, and equally effective as 
an antipyretic. The object of its administration is to reduce the heat, 
which is the most important source of danger. The amount required 
to accomplish this object is now definitely known. Twenty grains of 
the soda salt may be given every two hours, until the temperature is 
reduced to the proper point, at which it may be held by ten-grain 
doses at the same interval, unless the occurrence of an exacerbation 
requires the exhibition of a larger quantity. In the case of children, 
the daily quantity ranges from half a drachm to a drachm. Probably 
the best mode of administering the salt is in the form of wafer, but 
when these can not be obtained, a solution may be readily prepared, 
or the salt may be constructed extemporaneously by adding the acid 
to a solution of sodic carbonate as follows : Ijt Acid, salicylic, 3iv ; 
sodii bicarbonat., 3 j ; aquae, 1 jss ; syrup, simpl., 1 ss. M. A table- 
spoonful contains about twenty grains salicylate of soda. It should be 
borne in mind that this remedy is not safe if the heart is very weak, 
or if albuminuria is present. 

In relapsing fever, according to Riess, salicylic acid accomplishes 
something more than the mere reduction of temperature. Although 
it does not prevent the usual relapse, even when administered in large 
doses during the interval, it lessens the severity and duration of the 
relapse. It does not destroy the spirilla in the blood, nor indeed 
lessen their activity (Riess), and hence can not be a curative agent in 
this disease. In pyemia, septicemia, puerperal fever, diphtheria, 
etc., salicylate of sodium is used under the same rules as in typhoid. 
The indication for its use is high fever, and the good accomplished by 
it is determined by the degree in which the temperature is reduced. 
The antiseptic action is quite secondary to the antipyretic. In mala- 



342 ANTISEPTICS. 

rial fevers it was supposed by Senator and others, in the enthusiasm 
attending the introduction of the remedy, that salicylic acid would 
prove equal to quinine. If administered in a full dose just before the 
advent of a paroxysm, it will prevent it, but it does not possess the 
curative powers of quinine over the effects of the malarial poison, and 
hence will not prevent relapses. By using salicylate of sodium to 
abort an impending paroxysm, and quinine to prevent relapses, the 
curative result will be attained with the least pecuniary expenditure. 
In the mildest cases of intermittents, salicylate of sodium may be de- 
pended on alone, but, to succeed, it must be administered before the 
expected paroxysm. 

Out of the enormous mass of published experience in regard to the 
value of salicylic acid in acute rheumatism, it is difficult to select. 
From the first trials of Buss, followed by Strieker and Traube, there 
has been an almost unanimous expression of opinion by the German 
physicians in regard to the value of this agent in rheumatism. At 
first it was supposed that the disease could be invariably cut short in 
forty-eight hours to three days, but larger observation has qualified 
these opinions. By way of illustration of the measure of success now 
attained in Germany with salicylic acid in rheumatism, we may take 
the recently published statistics of Diesterweg. Of oue hundred cases 
treated with this remedy, the disease was cut short in thirty-six or 
twenty-four hours ; in eighty-five, within the period of forty-eight 
hours ; in ninety-eight, within seventy-two hours ; in one the disease 
was prolonged to eighty -four hours ; and in one the remedy had no 
effect on the disease. It is not intended to convey the impression that 
the cases got well in so short a time, only that the fever and joint- 
swelling and pain subsided, and convalescence was established. Re- 
lapses occurred in eleven cases, and cardiac complications in five. 

In France the treatment of acute rheumatism by salicylic acid was 
taken up by Jaccoud, Lepine, Gueneau de Mussy, and others, but es- 
pecially by Prof. See, who has devoted to it several important lectures. 
As a result of See's observation, he concludes that salicylic acid has a 
marked and peculiar benefit in acute rheumatism ; that the pains in- 
variably cease in from twelve to eighteen hours ; that the articular 
swelling disappears at the end of three days, and that the fever sub- 
sides with the pains. If the fever persists, other joints will become 
affected. Out of fifty-two cases treated by Prof. See, fifty-one recov- 
ered in from two to three days. These results are quite equal to the 
German. See makes an important observation in regard to the ra- 
pidity with which salicylic acid and salicylate of sodium are eliminated, 
and the necessity, therefore, of continuing the remedy for some time 
after all the joint- troubles have ceased, to prevent relapses. Prof. 
Gubler does not share the general enthusiasm as to the value of 
this agent in rheumatism. He emphasizes the uncertainty and the 



SALICYLIC ACID. 343 

dangers attending its use, and maintains that it has no antipyretic 
effects. 

In England salicylic acid and salicylate of sodium have been used 
with a large measure of success, but the rheumatism of England, as of 
this country, does not yield with the promptness characteristic of the 
Continental disease. The general results of the treatment, as con- 
ducted in England by Broadbent, Carafy, Spencer, Boggs, Greenhow, 
and many others, is very much as expressed by the last-named in his 
important communication to the Clinical Society. The temperature 
speedily falls, sometimes within a few hours and almost always in two 
or three days, the pulse declines at the same time, the pains subside 
correspondingly, and the joint-swelling diminishes and disappears 
within thre? or four days. Greenhow points out that such a result is 
not a cure even in the most favorable cases ; that the remedy acts 
very injuriously on the heart and causes a deep anaemia, and that, 
therefore, the duration of the disease, from beginning to the termina- 
tion, is not actually shortened. Dr. Maclagan (also Charteris) strongly 
urges the substitution of salicin, on the ground that it is equally effec- 
tive with salicylic acid and much less dangerous ; but it is difficult to 
appreciate this argument, since salicin is converted into salicylic acid 
in its passage through the system. 

In this country, the experience of the Maine physicians, and of the 
medical staff of the Massachusetts General Hospital, has been pub- 
lished. It is conceded that it has good effects. As regards the ex- 
perience at the Massachusetts General Hospital, the facts are as follows : 
In eight cases out of seventeen treated with salicylic acid, the duration 
of the longest case was twenty-six days, and the shortest five days, 
the improvement being very marked from the beginning of treatment. 
Of three patients who took salicylate of soda only, the duration of the 
disease was less than twelve days in each case, the shortest being two 
days. In the remaining nine cases the duration was six weeks or more. 

In summing up the testimony, it is clear that salicylate of soda is 
a most valuable remedy in acute rheumatism, but various unpleasant, 
even dangerous symptoms arise in some cases. Violent headache, ver- 
tigo, and tinnitus aurium, are common ; wild delirium is an occasional 
symptom ; weakness of the heart, obscuration of the first sound, and 
profound anaemia, are especially noted by Greenhow ; very great gas- 
trointestinal disturbance is now and then produced. Empis narrates 
a fatal case of acute rheumatism which was treated by salicylic acid. 
Great depression of the powers of life, in rare instances approaching 
collapse, has been observed. Sufficient is now known of the danger 
attending the salicylic medication of acute rheumatism, to justify the 
author in urging circumspection on the attention of his readers. The 
robust and vigorous rheumatics are proper subjects for this treatment, 
whereas, in the pale, feeble, and cachectic, especially those with weak 



344 EXCITO-MOTORS. 

hearts, this treatment must be pursued cautiously, or not undertaken 
at all. Relapses are frequent, probably because of the very rapid 
elimination of the remedy, as suggested by Prof. See, and hence its 
administration must be continued for some time after all of the local 
and systemic symptoms have subsided. 

In gout, chronic rheumatism, myalgia, and lumbago, salicylate of 
sodium often acts most serviceably. It is more effective the more 
acute the malady, as a rule, but it sometimes does great good in the 
most chronic cases. Abbott reports the cure of sciatica, and Brun of 
rheumatismal irido-choroiditis, by its use. The author has succeeded 
in some instances very promptly in the cure of sciatica by the salicy- 
late of soda — the formula used being that for the extemporaneous so- 
lution. The cases in which this remedy has proved most efficacious, 
were those of functional disturbance in the nerve, the muscles being 
in their normal condition, and the pain having nocturnal exacerbations. 

It is a very interesting fact, first distinctly stated by Dr. Pye 
Smith, of Guy's Hospital, London, that, during the administration of 
salicylic acid and the salicylates, the urine exhibits the reaction for 
sugar on the application of Trommer's test. This has been observed 
in rheumatism and in other diseases treated with this agent. The 
urine is a little increased in amount, but its specific gravity is not 
changed. The reduction of the copper is effected by the acid or by 
the glycogen, which is one of the products of the decomposition of 
salicylic acid. Mtiller, the assistant of Eckstein in the clinic at Kiel, 
has published some important observations on the use of salicylate of 
soda in the treatment of diabetes. It appears that full doses of the 
salt cause the sugar to disappear entirely, but this is not a permanent 
result, for, after a time, the sugar returns. A very great tolerance to 
the remedy exists in this disease, and large doses may be taken with 
impunity. Bouchardat, in commenting on these observations, states 
that he has not had good results from this treatment. Since, however, 
the remedy is well tolerated, and during its exhibition in considerable 
doses the sugar disappears, it may be used with advantage at critical 
times to stop the waste. 

Salicylate of sodium has feeble antiseptic properties, and hence 
salicylic acid, which is even superior to carbolic acid in its power to 
destroy minute organisms and to prevent change in putrescible mate- 
rials, should be preferred for all topical applications. Being free from 
odor, and more active than carbolic acid, it should be used instead 
of carbolic acid for most purposes. For all toilet purposes, it is decid- 
edly preferable. It is an excellent addition to the ordinary powder 
dentifrices, and its solution with borax is an efficient deodorant in fetid 
perspiration. This disagreeable affection, as it attacks the feet, may 
be relieved by dusting the feet thoroughly with powdered salicylic 
acid before putting on the stockings. It is useful, also, to fill the in- 



SALICYLIC ACID. 345 

terstices of the stockings with the powder. Extraordinary success has 
been achieved by the local apjolication of this remedy in eczema of the 
head and face. Those cases characterized by much weeping seem to 
be best adapted to the cure by salicylic acid, but eczema rubrum and 
eczema impetiginodes, that resisted other approved means, have yield- 
ed to the application of this agent (Wagner, Will). It is generally 
conceded that, as a local application to syphilitic idcers, salicylic acid 
is inferior to carbolic acid. 

The most important therapeutical uses of salicylic acid are in the 
antiseptic treatment of wounds and injuries. When it was shown 
that this agent had a power to destroy the activity of ferment and dis- 
ease-germs equal to that of carbolic acid, while it is free from the irri- 
tating quality and disagreeable odor of the latter, Thiersch, who is 
a strong advocate for Lister's antiseptic method, resorted to the use 
of salicylic-acid solutions. Further experience has, however, rather 
proved the superiority of carbolic acid in respect to the germicide and 
antiseptic properties for which these remedies are now so largely em- 
ployed. 

To cancer, gangrenous and sloughing wounds, pure salicylic acid 
may be applied in powder. To prevent the contact and multiplication 
of atmospheric germs, operative procedures may be conducted in sali- 
cylic spray, the sponges and dressings may be saturated with salicylic 
solutions, and the wound may be irrigated by the same. In order to 
carry out all the details of the antiseptic method, salicylic acid is sub- 
stituted for carbolic in the forms and combinations of dressings em- 
ployed by Lister. Wounds are covered with cotton-wool, impregnated 
with an alcoholic solution of the acid, in the proportion of three and ten 
per cent. As cold water takes up only one part to three hundred, 
which, however, is strong enough to destroy bacteria, etc., the addition 
of borax is generally, necessary to obtain a solution of sufficient strength 
for the antiseptic applications. A salicylic-acid plaster may be prepared 
as follows : Salicylic acid, 3 ss — 3 j ; white wax, 3 j ; paraffin, 3 ij ; 
almond-oil, 3 ij. The ingredients are melted, and rubbed up together 
in a heated mortar (Will), and spread on muslin. An ointment more 
readily melted by the heat of the body is the following : Sperm-oil, 
3 jss ; cacao-butter, 3 vss ; salicylic acid, 3 ss — 3 j. This should be 
melted together, thoroughly incorporated, and spread on lint (Will). 
An ointment for the same purposes may be prepared in a simpler way 
by the addition of salicylic acid to simple cerate. A solution of sali- 
cylic acid in olive-oil, in the proportion of one drachm to eight ounces, 
is an efficient local application for burns. 

Authorities referred to : 

Bose, Dr. H. Berliner Hinische Wochenschrift, 1875, No. 28. 

Buss, Dr. E. Die antipyretische Wirkung der Salicylsaure. Cent. f. d. med. Wissen- 
schaften, 1875, No. 18. 



346 ANTISEPTICS. 

Furbringer, Dr. Zur Wirkung der Salicylsaure, pamphlet, Jena, 1875. 

Immermann, Prof. Quoted in Liebermeister^s Handbuch der Patliologie und Tlierapie 
des Eiebers, Leipzig, 1875, p. 644. 

Kolbe, Prof. Ueber die antiseptischen Eigenschafter der Salicylsaure. Schmidt' 's Jahr- 
bucher, vol. clxiii, p. 229. 

Letzerich, Dr. Ludwig. Experimentellen Untersuchungen und Beobachtungen uber die 
Wirkung der Salicylsaure bei der Diphtheric Virchovfs Archiv, Band lxiv, p. 102. 

Moeli, Dr. Berliner klinische Wochenschrift, 1875, No. 30. 

Senator, Prof. Dr. Berliner klinische Wochenschrift, No. 32. 

Squibb, Dr. E. Note on Salicylic Acid, Brooklyn, 1875. 

Thiersch, Prof. Dr. Klinische Ergebnisse der Lister 'schen Wundbehandlung ', etc. 
Volkmami's klinischer Vortrage, Nos. 84 and 85. 

Traube, Dr. L. Berliner klinische Wochenschrift, No. 1, 1876. 

Will, Dr. J. C. Ogilvie. On Salicylic Acid. The Lancet, vol. ii, 1875, p. 870, et seq. 

Resorcin. (Not official.) 

History. — Resorcin is a chemical compound, discovered by Hlasi- 
wetz and Barth, and was obtained from certain resins by the action of 
fusing alkalies. They assigned to the new compound the name resorcin, 
partly because it is derived from a resin, and partly because it has 
some similarity to orcin, a peculiar substance obtained from archil. 
Subsequently resorcin was constructed synthetically by Korner, and 
at the present time it is obtained in various ways, the product being 
both pure and cheap (An deer). 

Properties. — Resorcin is a member of the phenol group. It oc- 
curs in tabular prismatic crystals, rather shining and lustrous, some- 
what sweetish to the taste, with a little after-pungency. When struck 
or rubbed in the dark, it appears phosphorescent. In odor it is some- 
what like phenol, but not nearly so pronounced. It is freely soluble 
in water, in the proportion of 86'4 parts of resorcin to 100 parts of 
water at 0° C. It is dissolved by all liquids except chloroform and 
carbon sulphide. Aqueous solutions exposed to the air and light, as- 
sume a more or less brownish tint, but without any apparent change 
in quality. Albuminous liquids treated with a concentrated solution 
of resorcin, become turbid by the formation of an albuminate of resor- 
cin. Various secondary products are obtained from it by the action 
of chlorine, iodine, bromine, nitric and nitrous acids, etc. In the pro- 
cess by which resorcin is produced, are also hydroqainone and pyrocate- 
chin. The best vehicles, according to Andeer, are alcohol, glycerin, 
and sirup of orange. The dose for usual purposes ranges from five to 
fifteen grains. For a decided antipyretic effect a drachm may be 
given, but this amount could not be frequently repeated. Five 
grains may be given every two hours, in an ordinary case. 

Antagonists. — From the physiological standpoint, resorcin is an- 
tagonized by the cerebral excitants, by the agents which raise the 
arterial tension, and by the cardiac and respiratory stimulants — by 
atropine especially. 



RESORCIN. 347 

Synergists. — Its effects are promoted by quinine, salicylic acid, 
carbolic acid, etc. 

Physiological Actions. — Resorcin does not irritate, nor is it ab- 
sorbed by the unbroken integument. The solution injected into the 
subcutaneous tissues produces but little irritation, and never inflam- 
mation and abscess. Applied to the moistened mucous membrane, it 
causes vesication, and a white blister forms, like that from carbolic 
acid. It has decided anti-ferment properties, arrests decomposition in 
animal tissues, deodorizes, and is destructive of the minute organisms 
on the presence of which putrefactive decomposition is dependent. A 
one-per-cent solution will prevent the decomposition of urine when 
exposed to the air for months ( Andeer). Applied to unhealthy wounds, 
it arrests the decomposition, destroys the fetor, and promotes healthy 
cicatrization (Dujardin-Beaumetz). 

The action of lethal doses is necessarily to be studied on animals. 
Murrell has, it is true, given a good account of the symptoms produced 
by an overdose, but the details can be obtained only by experiments 
on animals. Soon after the administration of a full dose — thirty cen- 
tigrammes (about five grains) of resorcin per kilogramme (about thirty- 
five ounces) weight of the animal experimented on — trembling begins, 
due to fibrillary contractions of the muscles, and this passes into gen- 
eral clonic convulsions of an epileptiform type. These convulsions 
regularly increase in severity, and, reaching their maximum in a few 
minutes, as regularly decline, the whole duration of this phase of the 
action being about two hours, sometimes longer. The spinal cord is 
doubtless the seat of the action, since the irritability of the peripheral 
nerves and muscles is diminished only, and not entirely destroyed. 
The general sensibility is preserved, whence it must be concluded that 
the action of resorcin is on the motor elements (Callias). The blood 
seems not to be altered in respect to its composition or properties ; it 
presents a normal appearance, coagulates in the usual manner, and the 
venous blood, exposed to the air, assumes the proper red hue. 

The lethal dose, according to weight, is ninety centigrammes per 
one kilogramme. The phenomena observed when such a dose is ad- 
ministered are the same as those above sketched, except that sensibility 
is impaired as well as motility. 

Resorcin, through the action on the nervous system, affects the 
respiration and circulation when the dose is large. At first the respi- 
ration is greatly increased in frequency, becomes convulsive and jerk- 
ing, and afterward shallow and weak but rapid. The action of the 
heart also becomes rapid, the pulse weak and somewhat irregular, but 
the respiration ceases before the action of the heart. The temperature 
rises, and just before death attains to 103° to 105° Fahr. This increase 
of the body-heat is doubtless correctly attributed to the extreme mus- 
cular action (Dujardin-Beaumetz), and not to irritation of a hypo- 



348 ANTISEPTICS. 

thetical heat-center. Resorcin, which acts in many respects so like 
quinine, however, differs from this agent remarkably in respect to the 
lethal effects. 

When a considerable dose of resorcin (thirty to sixty grains) is 
administered to a person in a fever, in a few minutes a sense of heat 
is felt about the epigastrium, and spreads thence over the system ; the 
face flushes and grows hot, the eyes glisten, the breathing and pulse 
are accelerated, and dizziness, with ringing in the ears, and frontal 
headache, are experienced. A good deal of discomfort, oppression of 
the chest, and a sense of distention of the head, are usually produced, 
but these sensations subside in from ten to fifteen minutes, the skin 
then grows moist, and in a few minutes more a profuse perspiration 
is pouring out on the surface of the body. The pulse then falls, cool- 
ness succeeds to heat, languor to tension, and the temperature of the 
body declines several degrees. If the feverish state has no special 
features, the lessening of the pulse and reduction of temperature to 
the normal occurs in about an hour. The pulse may be slowed one 
third, and the reduction of temperature be as much as three or more 
degrees of Centigrade or five degrees Fahr. (Lichtheim). The reduc- 
tion of temperature in fever is of comparatively brief duration, lasting 
from two to four hours. When the rise of temperature begins again, 
a sense of chilliness is experienced, which may even take the form of 
a distinct rigor. Lichtheim observed great differences in the power 
of resorcin in different fevers. The less the tendency to spontaneous 
remissions, the less the antipyretic effect. The fever accompanying 
pneumonia and erysipelas was less amenable to the action of resorcin 
than was typhoid fever, but no form of fever entirely resists its action. 
In the normal, the action on animals and on man corresponds closely. 
The correspondence also exists in respect to the action in pathological 
states, as above stated. To the information thus obtained may be 
added the experiences on healthy men, as furnished us by Andeer, by 
Baumann and Preusse, Fauber, and others. In small doses, the circu- 
lation, respiration, and temperature are but little affected. Andeer, 
from a dose of ten grammes (one hundred and fifty-five grains), suf- 
fered from dizziness, confused vision, deafness, considerable salivation ; 
presently extreme vertigo and loss of consciousness occurred, and then 
general clonic convulsions and tetanic rigidity of the muscles of the 
neck came on. There was no decline of temperature. All of the 
effects subsided in five hours. The preliminary stage of excitement 
produced by resorcin is often accompanied with excitement and de- 
lirium. In one case a deep stupor ; in others, muscular trembling and 
incoherence of speech were observed. 

The elimination of resorcin takes place almost entirely by the 
urine, and it is effected quite rapidly, for the greater part absorbed is 
excreted in an hour. The state of the kidneys, therefore, must influ- 



RESORCIN. 349 

ence the rate of elimination, and correspondingly the duration of the 
physiological or therapeutical actions. The tests for ascertaining the 
presence of resorcin are not sensitive for small quantities. The most 
easily applied is the solution of perchloride of iron, which causes, 
when resorcin is present, a deep violet, almost black, color. 

Therapy. — A close correspondence exists in the therapeutical ap- 
plications of the members of the phenol group, and Lichtheim traces 
a distinct parallelism between their anti-fermentative and antipyretic 
action. Resorcin, having much less irritating property, is generally 
preferable to carbolic acid for internal and for subcutaneous use. In 
catarrh of the stomach, gastralgia, ulceration, and fermentative indi- 
gestion, Andeer reports on a series of three hundred cases in which it 
acted most favorably. He prescribed chiefly a three-per-cent solution. 
In fevers it has been given with a view both to its antiseptic and anti- 
pyretic actions. It is not a specific, and is only serviceable in the ratio 
in which it reduces heat. In erysipelas, puerperal fever, septicemia, 
and diphtheria, resorcin may exert an antiseptic effect. For the same 
reason it may be applied to the treatment of ulcerative endocarditis. 
In intermittent fever remarkable results have been lately obtained, 
which, if confirmed, will put resorcin in the front rank of remedies for 
malarial diseases. Indeed, it is highly probable that in one of the 
members of this group we will presently have a real rival and an equal 
to quinine. 

Resorcin has been used by Dujardin-Beaumetz, Andeer, and others, 
with great success locally in syphilitic and other sores of an unhealthy 
or sloughing character. Its solution may be applied as spray in affec- 
tions of the nose and throat, catarrhal, ulcerating, or specific. Andeer 
affirms that, applied in crystals or in powder, it is the most efficient 
remedy in diphtheritic affections, and he has employed it with equal 
success in anthrax. 

Phenoresorcill. — By the term phenoresorcin is meant, by River- 
din, a mixture of carbolic acid and resorcin : sixty-seven parts of the 
former and thirty-three parts of the latter. This mixture crystallizes 
by cooling, and on the addition of ten per cent of water becomes 
a liquid which mixes with water in all proportions. Combining thus 
the virtues of both remedies, phenoresorcin offers many advantages, 
and may well repay more elaborate investigations. 

Hydro quinone and Pyrocatechin ; Kairine and Kairoline ; Chino- 
line. — In the search for an artificial quinine, produced by a syntheti- 
cal process, various substances, more or less closely related, have been 
formed. Of these, hydroquinone and pyrocatechine are very similar 
in all respects to resorcin. They correspond in physiological actions, 
and have the same power to depress febrile temperature. They are 
also closely allied to quinine chemically, and possess distinct antiperi- 
odic power. When first produced, they were proposed as substitutes 



350 ANTISEPTICS. 

for quinine ; the close chemical relationship was supposed to imply an 
equally close physiological affinity. Further studies have shown that 
while these agents are very useful, they are inferior in all respects to 
quinine. Hydroquinone and pyrocatechine are very closely allied to 
resorcin ; they may be substituted for this agent in corresponding 
doses, and they have the same range of applications. 

Katrine and Jcairoline are new contributions to the phenol group. 
Kairine is a powder having a pale buff color, is slightly soluble in 
water, and has a bitter, somewhat aromatic, and, to most persons, a 
very disagreeable taste. If inclosed in a wafer, which is the most 
agreeable mode of administering it, a quantity of water should be 
taken after it, to prevent the caustic action on the mucous membrane. 

Kairoline is, chemically, methyl-hydride of chinoline. It is very 
much less active than kairine, but the effects when produced are more 
lasting. The dose of kairine, as an antipyretic, is from fifteen to thirty 
grains, given in anticipation of the febrile rise, or it may be admin- 
istered in smaller doses at intervals — for example, five grains every 
hour, until the desired impression is effected. Kairoline, being less 
active by half, must be given in corresponding quantity. 

Chinoline. — So long ago as 1834 this substance was separated from 
coal-tar by Runge, and given the name Leukoline. Subsequently it 
was obtained by Gerhardt from the cinchona alkaloids, and by him the 
name chinoline or quinoline was assigned to it. Lately, chinoline has 
been produced synthetically by Skraup, by acting on aniline or nitro- 
benzol with glycerin in the presence of some dehydrating agent. 
Thus prepared, chinoline is an oily, highly refracting liquid and basic 
substance, which combines with acids to form salts. All of the salts, 
except the tartrate, are very deliquescent, crystallizing with difficulty, 
and soon losing their form ; but the tartrate is in lustrous crystals, 
stable even in a damp atmosphere, and yet sufficiently soluble in water. 
According to Donath, chinoline is not more closely allied to quinine 
in physiological and therapeutical actions than it is chemically. Al- 
though "these confident expectations, that in chinoline we have an 
adequate substitute for quinine, have not been realized, this remedy 
is still entitled to be regarded as a valuable antiseptic and antipyretic. 
Donath has shown that a two-per-cent solution will prevent the de- 
velopment of bacteria in decomposing solutions. Its power to reduce 
febrile heat is the same as that of the other agents of the group, except 
that it is greater. Indeed, chinoline is supposed to be nearly as active 
as quinine as an antipyretic. All of these phenol derivatives and con- 
geners — resorcin, hydroquinone, pyrocatechin, chinoline, etc. — possess 
the power to reduce fever-heat, while they are powerless to affect the 
normal temperature. The fall of temperature is preceded by a short 
period of excitement — of increased rate of cardiac movement, warmth 
of the surface, flushing of the face, etc. ; then perspiration begins, the 



BORACIC ACID. 351 

temperature declines, the pulse slows and becomes weaker, and the 
respirations lessen in number. The degree of antipyretic effect, and 
its duration, vary with the different members of the group. The be- 
havior of the several agents is set forth with sufficient particularity 
above. 

Therapy. — These antiseptic and antipyretic remedies have been 
employed with considerable success in fevers, in malarial and septic 
disorders. Topically, they are used to arrest the multiplication of 
minute organisms, and to prevent the septic decompositions dependent 
thereon. Thus, chinoline has been applied locally in diphtheria by 
Seiffert with great advantage. He used a five-per-cent solution of 
the tartrate, which was freely painted over the affected surface ; but, 
subsequently, he resorted to a five-per-cent solution of pure chinoline 
in equal parts of alcohol and water, as more effective and less disa- 
greeable. 

In intermittent and remittent malarial fevers, resorcin, but espe- 
cially hydroquinone, kairine, and chinoline, have been used with marked 
success. A true substitute for quinine has not yet been produced, 
but these remedies, especially the last mentioned, have approximated 
closely. Further exact observations are necessary to fix the true po- 
sition of these antipyretics and antiseptics. 

Authorities referred to : 

Andeer, Dr. Julius. Pamphlet, Ueber Resorcin. Abstract in New Remedies, Sep- 
tember and October, 1880. Also, Virchoio and Hirscfts Jahresbericht for 1881. 

Brieger, Dr. London Medical Record, April 15, 18S2. On the Therapeutic Value of 
Resorcin and Chinoline. 

Callias, Hippocrate. Be la Resorcine et son emploi en Therap. These de Paris, 1881. 

Donath, Dr. Quoted by London Medical Record and New Remedies. 

Dujardin-Beaumetz et Hippocrate Callias. De la Resorcine et de son emploi en 
T/ierapeutique. Bui. Gen. de Therap., vol. ci, p. 49. 

Dujardin-Beaumetz. ' D Union Med., April 2, 1881. On Resorcin for External Ap- 
plication. 

Filehne, Dr. De la Kairine et de la Kairoline. Journal de Therapeutique, March 
25, 1883. 

Lichtheim, Dr. Various papers on resorcin. Virchow und HirscJi's Jahresbericht 
for 1880 ; London Medical Record for 1881, 1882, etc. 

Murrell, Dr. William. Poisoning by Resorcin. The Medical Times and Gazette, 
October 22, 1881. 

Seiffert, Dr. London Medical Record, August 15, 1882. 

Acidum Boricum. — Boracic acid. Acide boracique, Fr. ; Bor- 
saare, Ger. 

Properties. — Boracic acid occurs in glittering, white, scaly crys- 
tals. It is soluble in twenty-six parts of cold and in three parts of 
<varm water, and is freely soluble in alcohol. 

Actions and Uses. — Boracic acid possesses decided antiseptic and 
deodorant properties. It arrests fermentations and putrefactive de- 



352 ANTISEPTICS. 

composition, and is destructive of minute organisms — bacteria, vibrio, 
etc. Applied to wounds, it is free from irritating effects ; it lessens 
suppuration, and prevents decomposition. 

Boracic acid occupies an important place in Lister's antiseptic 
method. It appears to be as effective as carbolic acid, and is even less 
irritating to the tissues than salicylic acid. A saturated solution may 
be employed as a dressing to fresh wounds to prevent the action of 
atmospheric germs, or to arrest decomposition in gangrenous, slough- 
ing, or ill-conditioned wounds. " Boracic lint " is made by steeping 
lint in a saturated solution of boracic acid at the boiling-point ; and, 
after drying, it is found to hold a large quantity of the acid, weighing 
nearly twice as much as before being thus treated. 

Mr. Lister's directions for the application of boracic-acid dressings 
to ulcers are as follows : " The first step is to cleanse the sore and the 
surrounding skin once for all from septic impurity. This is done by 
treating the surface of the sore freely with a solution of the chloride 
of zinc (forty grains to the ounce) ; and at the same time washing the 
integument with a strong watery solution of carbolic acid, which is 
used on account of its remarkable power of penetrating the epidermis, 
while for the sore itself the solution of the chloride appears to be more 
efficient. This preliminary step having been taken, the boracic dress- 
ing is at once employed as follows : A piece of oiled-silk protective, 
of sufficient size to cover the sore and slightly overlap the surrounding 
skin, is dipped in the boracic lotion (a saturated, watery solution) and 
applied, and over this a piece of boracic lint large enough to extend 
for an inch or more beyond the protective on all sides, the whole be- 
ing retained in position with a bandage." 

Mr. Lister has used boracic solutions with great success in pruritus 
ani, ulcers, slcin-grafting, burns and scalds, eczema, in operations on the 
penis, etc. By Mr. Watson, these solutions have been employed with 
excellent results in the dermatophyta ; for example, tinea tonsurans 
and t. circinata — especially " in that very troublesome form of the dis- 
ease which affects the scrotum and inner side of the thigh." 

Boracic ointment may be made as follows : " Take of boracic acid 
finely levigated, one part ; white wax, one part ; paraffin, two parts ; 
almond-oil, two parts. Melt the wax and paraffin by heating them 
with the oil, and stir the mixture briskly along with the boracic-acid 
powder in a warm mortar until the mixture thickens." When required 
for use, this ointment should be rubbed up with a little glycerin to 
the proper consistence, and then spread on muslin or linen. 

Boracic acid may be employed in all the various forms and combi- 
nations in which carbolic and salicylic acids are now used by the anti- 
septic method. 

Borocitrate of magnesia, originally proposed by Becker, has been 
recently strongly urged by Madsen as a solvent of urinary calculi of 



BENZOIN. 353 

the uric-acid variety. It may be extemporaneously prepared as fol- 
lows : 5 Magnesii carbonat., 3 j ; acid, citric, 3 ij ; sodii biborat., 
3 ij ; aquae bul., § viij. M. Sig. : A tablespoon!" ul three or four times 
a day. 

Tartraborate of potassium is, probably, a more generally useful 
remedy for the purpose above indicated, as the potash compounds of 
uric acid are more soluble than the soda compounds. As a solvent of 
uric-acid calculi, this salt is preferable. It is obtained by heating to- 
gether four parts of cream of tartar, one part of boracic acid, and ten 
parts of water. It is a white powder, or occurs in transparent scales, 
has an acidulous taste, and dissolves in two parts of cold water. A 
scruple may be given three or four times a day in water, and the more 
largely diluted it is, the better when used for the solution of calculi. 

Authorities referred to : 

Husemann, Dr. Theodor. Handbuch der gesammten Arzneimittellehre, erster Band, 
p. 284. 

Lister, Prop. Joseph. On Recent Improvements in the Details of Antiseptic Surgery. 
The Lancet, vol. i, 1875. 

Watson, Mr. Indian Medical Gazette. The Lancet, vol. ii, 1875, p. 750. 

Benzoinum. — Benzoin. A solid balsam obtained from Styrax ben- 
zoin. Benjoin, Fr. ; Benzoeharz, Ger. 

Composition. — Benzoin is made up of resins. When subjected to 
dry distillation it yields benzoic acid, which is contained in it in the 
proportion of fourteen to eighteen per cent. Certain varieties of ben- 
zoin contain, also, cinnamie acid. 

Tinctura Benzoini. — Tincture of benzoin, twenty parts ; alcohol, 
sufficient to make one hundred parts. Dose, 3 ss — 3 j. 

Adeps Benzoinatus. — Benzoinated lard. Benzoin, two parts ; lard, 
one hundred parts. 

Tinctura Benzoini Composita. — Compound tincture of benzoin. 
(Benzoin, socotrine aloes, storax, balsam of tolu, alcohol.) Dose, 3 ss 

- 3 ij- 

Acidum Benzoicwn. — Benzoic acid. Is in white, feathery crystals, 
of a peculiar, agreeable odor, and warm, acidulous taste, sparingly sol- 
uble in cold water, more soluble in boiling water, which deposits it in 
part on cooling, and very soluble in alcohol. Dose, gr. v — 3 ss. 

Ammonii Benzoas. — Benzoate of ammonia. Is in minute, white, 
shining, thin, four-sided, laminar crystals, with a slight odor of official 
benzoic acid, and a bitterish, saline, somewhat balsamic taste, and 
slightly acrid but persistent after-taste. It is soluble in five parts of 
water and in twenty-eight parts of alcohol. Dose, grs. v— 3 ss. 

Sodii Benzoas. — Benzoate of sodium. A white, semi-crystalline 
or amorphous powder, efflorescent on exposure to air, odorless, or hav- 
ing a faint odor of benzoin, of a sweetly astringent taste, and neutral 
23 



354 ANTISEPTICS. 

reaction. Soluble in 1 -8 parts of water, and in forty-five parts of alco- 
hol at 60 Fahr. Dose, gr. v — 3 j. 

Actions and Uses. — The physiological effects of benzoin and its 
preparations are due to benzoic acid. Taken in very considerable 
doses ( 3 ss), benzoic acid produces some epigastric heat, increases the 
pulse-rate, and promotes bronchial and cutaneous transpiration. The 
acidity of the urine is rendered more decided by it. A large part of 
the acid is excreted by the kidneys as benzoic acid, and a part under- 
goes conversion into hippuric acid. 

Recent observations have shown that benzoic acid has decided an- 
tiseptic properties (Salkowsky). It manifests the same power to pre- 
vent fermentations and putrefaction, and to destroy minute organisms, 
as that possessed by salicylic and boracic acids. 

The tinctures of benzoin were formerly used as expectorants in 
chronic bronchial affections. They are now sometimes resorted to for 
the local treatment (by atomization) of chronic laryngeal affections. 
Their most important use, however, is in the treatment of foul-smelling 
wounds, flabby granulations, etc. Unhealthy or sloughing wounds 
may be dressed with linen or cotton cloths saturated with the tinctures, 
with the effect to destroy fetor and stimulate to a more healthy growth. 
Chapped hands and lips and fissured nipples are best treated, accord- 
ing to Stille, with a mixture of compound tincture of benzoin and 
glycerin. Benzoic acid may be used as a substitute for boracic and 
salicylic acids in the antiseptic treatment of wounds. Its solubility in 
water can be increased by the addition of borax. 

Benzoate of ammonia is a remedy of great utility when the urine is 
ammoniacal and loaded ivith phosphates. Under its use the urine be- 
comes acid, and the fermentative changes are arrested. In chronic 
cystitis, arising from any cause, this remedy should be prescribed when 
the urine undergoes the alkaline fermentation. Incontinence of urine, 
when due to an alkaline reaction of this excretion, is cured by the ben- 
zoate of ammonia. Phosphatic calcidi may be dissolved by the long- 
continued use of this remedy. 

Benzoate of sodium has lately occupied a large place in profes- 
sional attention. Having similar antiseptic and antipyretic properties 
to those of salicylate of sodium, and being without any injurious effect, 
it came to be largely used in the septic maladies. The first important 
observations were those of Dr. Klebs, of Prague, who announced that 
this salt can be used with good effects in all infectious febrile diseases ; 
that while the febrile movement does not cease as quickly as after the 
use of sulphate of quinine and salicylate of sodium, the results obtained 
from the benzoate are more permanent. Moreover, absolutely no un- 
pleasant after-effects were observed from this remedy, even when its 
use was much prolonged, and as much as three hundred and eighty 
grains daily could be taken without inconvenience. The usual daily 



BENZOIN. 355 

quantity required in the treatment of diseases is ten to fifteen grammes, 
or one hundred and fifty to one hundred and eighty grains. Dr. Klebs 
advised the use of benzoate of soda in the acute infectious diseases, in 
tuberculosis, and catarrh of the bronchi. The principle underlying 
these suggestions of Dr. Klebs is the antiseptic. He holds that the 
maladies in question are of parasitic origin. The appropriate remedy 
is an antiseptic, destructive of germs. There are several remedies 
having these powers, but benzoate of sodium is best, because, while 
very destructive of minute organisms, it is free from injurious effects 
on the body. A remarkable and sudden extension was given to the 
use of this salt by the report from Innspruck, that cases of consump- 
tion far advanced were being quickly cured in the clinic of Prof. 
Propop Rokitansky. Subsequent investigations proved the inaccu- 
racy of such observations. Klebs held that he had proved the para- 
sitic origin of phthisis, and Prof. Schuller, of Greifswald, confirmed 
his statements by additional experiments. It was discovered in 
Klebs's laboratory that, if animals were made to inhale the spray of 
benzoate of sodium, tubercular and diphtheritic matter did not affect 
them. Then followed the treatment of cases of consumption, by spray 
of a solution of the benzoate. Although the first claims put forth 
were greatly exaggerated — not entirely unfounded — there is reason to 
believe that the free use of benzoate spray is of service in some cases 
of consumption. According to the estimate of Rokitansky (Propop), 
the patient must inhale l0 1 00 of the body-weight daily of the ben- 
zoate in the form of spray, to do any good. Among the numerous 
observations in opposition to the views of Klebs and bis followers, may 
be selected those of Guttmann, who found that the treatment did not 
relieve a single symptom, and that there was no appearance in the 
affected lungs of any attempt at reparation. 

Benzoate of sodium has been used in other infectious diseases. 
Thus Letzerich has employed it with success in the teatment of diph- 
theria. Of twenty-seven cases treated with this remedy in one epi- 
demic, only one proved fatal, and this was an infant of feeble consti- 
tution. He gave from five to twenty grammes daily (seventy-five to 
three hundred grains), according to age, and applied the powdered 
benzoate by insufflation to the diseased parts. Other physicians have 
not been so largely successful, but many very favorable reports have 
been published (Kien, Hoffmann). Thus Demme found it highly ser- 
viceable in diphtheria and scarlet fever. It is well established that 
benzoate of sodium, added to the diphtheritic fungus, renders it harm- 
less, so that the local use is founded on sound reasons. As an anti- 
pyretic in the eruptive fevers, in typhoid, and in malarial fevers, this 
salt may be preferred to the salicylate, than which it is safer, although 
much less effective as an antipyretic. In acute rheumatism it has been 
administered by Senator, McEwan, and others, who have found it a 



356 ANTISEPTICS. 

good and safe remedy, but not so active as salicylic acid. Tordens 
has treated whooping-cough successfully, using the prescription of 
Letzerich : ^ Sodii benzoat., 3i\ ; aquae destil., aquae menth. pip., 
aa 3 x ; syrup, aurantii, 3 ij. M. Sig. : Two drachms every hour 
or two. 

Authorities referred to : 

Demme, Dr. Allg. Wiener med. Zeilung, No. 24, 1880. 
Guttmann, Dr. Paul. Berliner klin. Wochen., December 8, 1879. 
Klebs, Dr. Allg. med. Centralzeitung, June 5, 1878. 
Kohler und Dittel. Berl. klin. Woch., No. 44, 1879. 
Letzerich, Dr. Berliner klinische Wochen., No. 1, 1879. 
McEwan, Dr. David. British Medical Journal, March, 1881, p. 336. 
Salkowsky, Dr. E. VirchovPs Archiv, Band lxxviii, p. 30. 
Senator, Dr. Zeitschrift fur klinische Med., Band i, p. 41. 

Tordens, Dr. Edouard. Jour, de Med. de Brux., May, 1880. London Med. Record, 
August 15, 1880. - 

Antiseptic Oils. — Oleum Caryophylli. Oil of cloves. 

Composition. — Oil of cloves consists of two substances — a hydro- 
carbon, light oil of cloves, and an oxygenated oil, eugenol, which has 
acid properties, and is therefore called eugenic acid. The light oil of 
cloves is isomeric with the oils of turpentine, copaiba, and cubebs. 

Salicylic acid and a camphor known as caryophyllin are also con- 
stituents of the oil of cloves. Dose, gtt. ij— gtt. v. 

Oleum Gaultherice. — Oil of gaultheria. 

Spiritus Gaidtherim. — (Oil of gaultheria, 3 parts ; alcohol, 97 parts.) 
Dose, 3 ss — 3 ij. 

Composition. — Oil of gaultheria contains a hydrocarbon, gaulthe- 
rilen, and an acid, methysalicylic acid, to which the acid reaction of 
the oil is due. Dose, gtt. v — gtt. xx. 

Oil of gaultheria has been proposed and used successfully as a 
substitute for salicylic acid in the treatment of rheumatism, gout, and 
affections dependent on these diatheses respectively. It is best given 
in the form of an emulsion, and it may be combined with other agents 
having corresponding powers : thus — 1> Olei gaultheriae, 3 j ; acidi 
salicylici, 3iv ; sodii biborat., 3j; syrup, picis. liquid., § ij ; aquae 
anisi, 3 ij. M. Sig. : Two teaspoonfuls every four hours. 

Oleum Thymi. — Oil of thyme. The volatile oil obtained from 
Thymus vulgaris. 

Composition. — Oil of thyme contains a hydrocarbon which, by 
fractional distillation, is resolvable into cymene and thymene. Its 
most important constituent is a solid crystalline substance, having 
acid properties and homologous with carbolic acid. This is known as 
thymol, or thymic acid. Dose, gr. ij — gr. x. 

Oleum Cajuputi. — Oil of cajeput. The volatile oil obtained from 
the leaves of Melaleuca cajuputi. Dose, gr. v — gr. xx. 



ANTISEPTIC OILS. 357 

Composition. — The most important constituent of the oil of caje- 
put is cajuputol, or the bihydrate of cajuputene. 

To this list might be added eucalyptol, the camphor obtained from 
Eucalyptus globulus, and the various balsams, and cymene and terpene 
volatile oils ; but these remedies have already been considered else- 
where, so far as they possess any practical importance. 

Physiological Actions. — The composition of this group of oils 
indicates the close correspondence between them and carbolic, salicylic, 
and benzoic acids. So intimate are the chemical relations of salicylic 
acid, benzoic and cinnamic acids, that the balsams might with pro- 
priety be grouped with the antiseptics, for in their physiological ac- 
tions and therapeutical applications they are equally as closely related 
as in their elementary composition. 

Of the members of this group, thymol or thymic acid has been 
most elaborately studied. Lewin has shown that thymol, as respects 
its influence on fermentation and putrefaction, has a positive antiseptic 
property. Its actions are similar to those acids of the same class to 
which it is so closely allied chemically, viz., carbolic, salicylic, and 
benzoic. Locally applied, thymol, just as carbolic acid, produces pa- 
ralysis of the end-organs of the sensory nerves (Lewin). 

The effects of thymol have also been studied by Baltz. He has 
ascertained that from twenty to thirty grains a day are necessary to 
produce distinct effects. Placed in contact with the fauces, it causes 
an acrid sensation, which persists. It rarely excites vomiting, but a 
large dose induces a sensation of heat about the epigastrium, and 
sometimes diarrhoea. In the majority of cases thymol causes, in about 
half an hour to an hour, sweating more or less profuse, but distinctly 
less than that produced by salicylic acid and jaborandi. The urinary 
secretion is sometimes increased. The urine presents a dark, greenish 
hue, as if it contained blood. Singing in the ears, deafness, and a sen- 
sation of constriction of the forehead, are among the nervous phe- 
nomena. The researches of Lewin and Baltz place thymol in the same 
category with eucalyptol, salicin, salicylic acid, resorcin, and carbolic 
acid. 

Myrtol. — This new antiseptic has the same relative origin as thy- 
mol ; it is derived from the myrtle and is an oil, isomeric with the oil 
of turpentine (?). It is a very active antiseptic (Gubler). It prevents 
the decomposition of urine and other putrescible animal substances, 
and has been used to destroy the fetor of decomposing pus. As an 
active parasiticide it has been used successfully against the round 
worm, and the ascarides infesting the rectum. By Laboulbene it has 
been prescribed for the expulsion of taenia, with only partial success. 
The parasitic affections of the skin, favus, herpes, and pityriasis, are 
cured by myrtol. 

In moderate doses this agent is rather grateful to the stomach, and 



358 AGENTS ACTING ON THE NERVOUS SYSTEM. 

is a stomachic tonic or stimulant. The most important application 
made of it is in the treatment of bronchorrhoea, fetid bronchitis, gan- 
grene of the lung, etc. Eliminated by the lungs largely, it stimulates 
the tissues through which it passes, and thus a local action is added to 
the systemic effect. Chronic bronchitis, capillary bronchitis, whoop- 
ing-cough, humid asthma, etc., are maladies in which it may be ex- 
pected to afford a large measure of relief. In hematuria not due to 
acute congestion, and in passive hemorrhages in general, it has been 
used with success. 

It has long been known that oil of cloves, and indeed the essential 
oils generally, have the power to relieve a painful state of a sensory 
nerve. Inserted into the cavity of an aching tooth, they suspend the 
pain. A solution of oil of cloves in rhigolene is a nostrum for the 
cure of superficial neuralgim. 3 01. caryophylli, ol. gaultherise, ol. 
thymii, aa 3 j ; tinct. benzoini, tinct. cinnamomi, aa f iv. M. Sig. : 
Apply on lint, a?id cover with oiled silk. 

The oil of cloves is the most effective deodorizer for sponge-tents 
hitherto employed. 

The essential oils dissolved in alcohol (essence or tincture) are 
much used to correct flatulence. 

Cajeput-oil has been used successfully in cholera, cholera-morbus, 
and nervous vomiting. 3 01. cajuputi, 3 j ; spts. chloroformi, tinct. 
cinnamomi, aa 3 j. M. Sig. : A teaspoonful every half hour in gly- 
cerin or sirup and water. As a parasiticide, cajeput-oil is an effective 
local application in parasitic skin-diseases — scabies, tinea, pityriasis, 
etc. — and in the form of enema, in a suitable vehicle, against ascarides 
vermiculares. 



AGENTS USED TO MODIFY THE FUNCTIONS OF THE 
NERVOUS SYSTEM. 

In this division, remedies are employed with a view to their influ- 
ence over the functions of the nervous system. They do not, immedi- 
ately or necessarily, affect the function of nutrition; they do not enter 
into the formation of tissues ; and, having modified the functions of 
the nervous system, they are excreted from the organism in the form 
in which they entered it. It is probable that the selective action on 
this system is due to the fact that the nervous tissue is the most 
highly specialized in function, and therefore most susceptible to such 
impressions. 

The different parts of the nervous system are so closely united in 
function that a disturbance at any point is differentiated to other and 
often widely-separated points, and the complexus of effects is made 
up of many minor disturbances. For this reason it is quite impos- 



ELECTRICITY. 359 

sible, in the present state of our knowledge, to make a classification 
which will sharply define the limits of activity of any particular rem- 
edy. Nevertheless, physiological experiment and clinical experience 
have furnished us sufficiently accurate information with regard to the 
most important actions of the remedies of this division, to justify an 
arrangement based on their most conspicuous qualities. 



AGENTS WHOSE MOST IMPORTANT QUALITY CONSISTS IN 
EXCITING FUNCTIONAL ACTIVITY. 

A.— OF THE SPINAL CORD AND SYMPATHETIC. 

Electricity. — Electricity Fr. ; Electricitat, Ger. 

Forms of Electrical Force employed in Medical Practice. — Mag- 
netism, static or frictional electricity (franklinism), galvanism, fara- 
dism (electro-magnetic, magneto-electric). 

Static or Frictional Electricity. 
This is obtained by friction from glass, as in the cylinder or plate, 
and by induction from the Holtz electrical machine. The last-named 
instrument is best adapted for medical use. The prime conductor of 
the electrical machine furnishes positive or vitreous electricity, and 
the rubber, negative or resinous. Various modes of electrization by 
static electricity are resorted to : 

1. By sparks. In this mode the part to be acted on is made to re- 
ceive sparks from the machine in action. 

2. The electric bath. The patient is placed on an insulated stool, 
and is charged with positive or negative electricity from the prime 
conductor, or rubber, according as he is in connection with either. 
Sparks maybe drawn from the affected part by presenting the knuckles 
or a metallic conductor. A sharp, tingling sensation, followed by red- 
ness and wheals, is produced by sparks, whether received from the 
machine or drawn from the body. 

3. By the Leyden-jar. In this method, the electricity is condensed 
in the Leyden-jar, and the charge is transmitted through the part to 
be acted on. 

Owing chiefly to the physicians of Guy's Hospital, London, and 
Dr. Charcot and his pupils, Dr. Arthius and Dr. Vigouroux, of Paris, 
the use of static electricity as a therapeutical agent has been revived 
and rendered entirely practicable. Dr. Morton, of New York, and the 
author, simultaneously arrived at a method of using the Holtz electri- 
cal machine as a means of stimulating muscular contractions, and as 
a substitute for the faradic current in cases requiring such treatment. 
Before describing these manipulations it is necessary to say something 
regarding the structure of the Holtz machine. Various modifications 
of the original pattern have been introduced ; but the most successful is 



360 



EXCITO-MOTORS. 



that of Toepler. There are, however, several excellent machines 
adapted from the Holtz model to suit the views of mechanical theo- 
rists or practical electricians, which may be employed with entire confi- 
dence. The author has used with satisfaction a machine the revolv- 
ing plate of which has a diameter of fourteen inches and the fixed plate 
of sixteen inches. The power may be furnished by an electric motor, 
by a water motor or more conveniently by an assistant. In the an- 
nexed figure, the arrangement of the Toepler-Holtz is shown. This is 




Fig. 1.— The Toepler-Holtz Electrical Machine. 

the model which the author uses, and is found to be sufficiently powerful 
for medical purposes. During the winter, when the consultation-room 
is kept at or about 70° Fahr. by artificial heat, this instrument works 
with entire satisfaction. In the late spring and summer, for the most 
part, the atmospherical conditions are such that some means are neces- 
sary to preserve the instrument from moisture. This is accomplished 
by inclosing the machine in a suitable glass case and keeping within 
it some chloride of calcium to absorb the moisture. An arrangement of 
this kind is preferred by Dr. Morton, of New York, who uses the origi- 
nal Holtz machine. 

The Holtz machine may also be employed to procure the muscular 
effects, hitherto obtained only from faradic appliances. The current 
passing between the discharging-rods can be tapped by means of a flex- 
ible wire attached to the outer coating of one condenser, and another 
flexible wire connected with the brass knob or bar which is in communi- 
cation with the interior of the other condenser. The strength of the 
current and the rapidity of the interruptions are regulated by the dis- 
tance between the knobs of the discharging-rods. At every passage of 



ELECTRICITY. 



361 



a spark a muscular action takes place. If the knobs are placed very- 
near each other, so rapidly do the sparks pass, that the effect produced 
is very like that obtained from a mild faradic current. Thus, by an 
arrangement of the machine which can be done on the instant, the 
actions, heretofore only obtainable from the faradic machines, are 
readily procured from the statical electrical instrument. Besides the 
effectiveness of this method, it has the advantage that it is almost pain- 
less. In no other way can strong muscular contractions be induced with 
so little pain, at least. 

Magnetism. 
Magnets are natural or artificial. The former consist of a native 
iron-ore possessed of the magnetic property ; the latter are pieces 
of steel in which the magnetic property has been induced. This 
magnetic property consists in the power to attract pieces of iron 
and steel, in maintaining a certain fixed position when suspended 
to move freely, and in attracting or repelling the extremities of other 
similar magnets. A magnet suspended, free to move, always points 
in a certain direction, north and south. That end pointing north is 
the "marked" extremity, because it has a mark, notch, or groove, 
or the letter JV, to indicate it. Because of this property, the mag- 
net is said to have "poles," or polarity. The poles behave toward 
each other in a certain definite way : Unlike poles attract ; like poles 
repel, is the law. When a bar-magnet is made to approach a mag- 
netic needle moving on a pivot or suspended, there ensues attrac- 
tion or repulsion, according to the polarity of the 
extremities approximated. When a certain prox- 
imity is attained, yet some distance short of actual 
contact, the magnetic influence is exerted, and at- 
traction or repulsion, according to the pole, takes 
place. If a bar of soft iron, not magnetized, is sus- 
pended, on the approach of a permanent magnet, the 
former is seen to move toward the latter when they 
are approximated. The magnetic force is thus ex- 
erted through an intervening space : inversely as the 
square of the distance, is the law, which expresses 
this action in mathematical form. To this property 
is applied the term magnetic induction. When the 
soft iron is acted on by a sufficiently powerful mag- 
net, it ceases to be in a neutral or unexcited state, 
the magnetic property is induced in it, and for the 
time being it assumes the polar condition ; but not 
possessing the coercitive property — i. e., the prop- 
erty to retain the magnetism induced in it — soon returns to its former 
neutral condition. Steel, having the coercitive property, is the ma- 
terial out of which permanent magnets are made. The magnetic prop- 




Fig. 2.— Compound 
Magnet. 



362 



EXCITO-MOTORS. 



erty is induced in such pieces of steel by the contact of other permanent 
magnets. When once induced, the magnetic property may be readily 
destroyed by a powerful blow, by repeated scratching, and by heating. 
When a magnet is broken into several fragments, each piece has 
the same polarity. The forms of magnets are the bar and horseshoe, 
chiefly — the latter being more convenient, and also better retaining its 
power, because an armature can be kept in position. A compound 
horseshoe magnet is usually preferred for medical use, because of the 
proximity of the poles, but the straight form (Fig. 2) is also used. 

Galvanism. 
All chemical action is accompanied by electrical phenomena. The 
electricity furnished by the galvanic combinations in use is derived 




Fig. 3.— Galvanic Battekt. 

from a chemical action which takes place in the elements. These 
are of various forms. Reduced to its simplest condition, a galvanic 
combination consists of two substances, one of which can be acted on 
chemically, while the other has merely the conducting property ; and 

also of a material — a fluid, usually — 
which can excite the chemical action. 
There is, then, a generating plate or 
element, usually of zinc, a conducting 
plate or element of copper or car- 
bon, usually, and a fluid or semi-solid 
which acts on the zinc, setting up 
the chemical action. When such ele- 
ments with the exciting fluid are 
placed in a glass or earthen vessel, 
the whole combination is called a 
galvanic cell or couplet, and when 
several of these are united they form 
a battery (Fig. 3). 
Galvanic cells may have a single or two fluids : the single fluid is 
not constant ; in the two-fluid, there are arrangements, partly mechan- 
ical, chiefly chemical, for securing constancy in the current. In Fig. 4 




Fig. 4.— A Cell. 



ELECTRICITY. 



363 



we have two metals — zinc, z, and copper, c — united by the wire, M, 
placed in a glass vessel containing dilute sulphuric acid. The chem- 
ical action in such a cell consists in the formation of the sulphate of 
zinc, the water being decomposed, and hydrogen appearing at the 
surface of the copper. Such an arrangement may be denned to be a 
means of making a difference in potential between two points. Elec- 
tricity flows from the higher to the lower potential. The point where 
the chemical action is taking place — the surface of the zinc — is the 
higher potential, and hence "the current" passes from this through 
the liquid to the lower potential, the copper, which is the conducting 
plate. Now, as the current always flows from the higher to the lower 
potential, it follows that, outside of the element, the copper becomes 
positive and the zinc negative, for the current passes through the 
" conjunctive wire " from the former element to the latter. It follows 
that such an " element," or " cup," can not furnish a constant current. 
The chemical action soon rises to the maximum, the sulphuric acid 
combines with the zinc, and hence the exciting fluid is soon nothing 
more than a saturated solution of zinc sulphate, while the hydrogen 
accumulates on the copper plate. The chemical action, therefore, 
quickly subsides, and the hydrogen-bubbles hinder the passage of the 
current by the conducting plate. Elements of this kind are usually 
employed to run faradic machines, but they are not suited for gal- 




Fig. 5.— Daniell's Element. 



vanic batteries, since the tension of the current varies so much in a 
short time, and the action soou ceases. 

The two-fluid cells, in which the chemical action is less violent, 
and mechanical devices prevent the polarization of the hydrogen, are 



364 



EXCITO-HOTORS. 



alone suited to medical uses. Only those ascertained by experience to 
be adapted to medical purposes can be referred to. One of the ear- 
liest two-fluid cell batteries constructed was that of Daniell (Fig. 5). 
The arrangement of the parts in this cell will illustrate the principles 
concerned in such galvanic combinations. The zinc and copper ele- 
ments and the two liquids are separated by a porous cup of unglazed 
earthenware. The zinc, z, is outside, and is a cylinder having a cleft ; 
about it is diluted sulphuric acid (1 part to 16 of water). The copper, 
c, is contained in the porous cup, and is surrounded by a saturated so- 
lution of copper sulphate, which is kept at the point of saturation by 
a quantity of the crystals packed around the copper element. The 
polarization of the hydrogen is prevented by chemical means, for in 
the decomposition of copper sulphate the hydrogen combines with 
oxygen to form water, while metallic copper is deposited on the copper 
element. The Daniell, as modified by the celebrated Dr. Remak, of 
Berlin, has been more widely used for medical purposes than any other 
cell, and still maintains its superiority. In this arrangement made by 
Siemens and Halske, of Berlin, and known under their name, besides 
the porous cup, a quantity of papier-mache, or paper-pulp, is packed 



tfTfctTtfyj* 




. — Bunsen Cell. 



in between the elements, and, while the copper is surrounded by cop- 
per sulphate in solution, only water is used with the zinc. In the de- 
composition, copper is deposited on the copper element and sulphuric 
acid diffuses through into the zinc compartment. This cup is remark- 
able for the uniform tension of the current, for constancy, and for 
economy. A " gravity battery," composed of zinc and copper elements, 



ELECTRICITY. 



365 



zinc sulphate solution about the zinc, and copper sulphate solution 
about the copper, and separated merely by the specific gravity of the 
respective solutions, is now much employed in telegraphy, and to a 
considerable extent in medical practice. Zinc and carbon are now 
utilized in two-fluid as in one-fluid cells. The Bunsen combination 
is a most efficient one (Figs. 6 and 7). The outer zinc plate has a 




Fig. 7.— Btjnsen Battery. 

cleft, and is immersed in dilute sulphuric acid, while the carbon, of the 
variety known as gas-carbon, is contained in a porous cup with strong 
nitric acid. Here the hydrogen is intercepted by the nitric acid, ni- 
trous-acid fumes are given off, and sulphate of zinc is formed. It is 
a very powerful combination, but the fumes of nitrous acid make it 
very objectionable. Although it is not suited for medical use in gen- 
eral, it is well adapted for galvano-caustic purposes. Mr. De la Rue's 
chloride-of-silver battery is admirably well arranged for forming a 
portable or permanent combination for the medical electrician. It 
may be made of test-tubes, closed with a rubber stopper containing 
two orifices for the elements, which consist of a zinc rod and flat- 
tened silver wire. At the bottom of the tube is placed some chlo- 
ride of silver, and above this a solution of common salt. The silver 
element dips down into the chloride of silver, and above this is in- 
sulated by sheet gutta-percha. This cell has an electro-motive force 
a little more than the Daniell, and it is remarkably constant, portable, 
and unchangeable. A very efficient and at the same time economical 
cell can be constructed of a tin can, iron filings, a porous cup, and a 
rod of zinc. In the porous cup, about the rod of zinc, is put some 
common potash, and the iron fillings which form the positive element 
are packed around the porous cup. 

Besides the above, mention should be made of the two-fluid bichro- 
mate of potash cell. A solution of the bichromate in dilute sulphuric 
acid is now chiefly used as the exciting fluid in single-fluid cells ; but, 
in the two-fluid arrangement, the carbon element is placed in a porous 
cell containing a saturated solution of bichromate of potash in water 



366 EXCITO-MOTORS. 

only, and the zinc element is acted on by very dilute sulphuric acid 
(1 to 20). The performance of this cell is in a high degree satisfactory. 
The carbon in this, as in the other galvanic cells, is gas-carbon, which 
is remarkable for its density and for conducting power. The zinc is 
ordinary commercial zinc, amalgamated. The process of amalgama- 
tion consists in first immersing the zinc plate or rod in dilute sulphuric 
acid to make a clean surface, and then rubbing it with a little mercury 
until it presents a silvery whiteness. A homogeneous surface is thus 
made, and the loss of power due to the formation of innumerable 
couplets of zinc with the impurities contained in it is thereby pre- 
vented. 

The force generated in the cup by the chemical action is termed 
electro-motive force, and it is the difference in potential between the 
two elements. The power of any combination of cups is the sum of 
the electro-motive force of each one less the difference caused by re- 
sistance in the circuit. The current from a battery has strength, ten- 
sion, and quantity. The strength is the amount transmitted in the 
unit of time, along a given conductor ; tension is the power to over- 
come resistance ; and volume is the net quantity available. There 
are various objects which offer resistance to the passage of the current. 
The circuit of a galvanic battery consists of the space between the 
elements in the cup, the conducting element, and the wire which unites 
the poles — the conjunctive wire. The current passing over this circuit 
has to overcome the resistance opposed by these several parts. The 
conjunctive wire offers a degree of resistance determined by its length 
and section. A single large cup, having zinc and carbon elements of 
corresponding size, excited by bichromate solution, will heat to red- 
ness, even volatilize a platinum wire, while twenty small medical-bat- 
tery cups connected in series will scarcely warm such a wire. Inten- 
sity, resistance, and quantity, are now given a mathematical mode of 
expression. The unit of electro-motive force is the volt, in honor of 
Volta, and is very nearly the power of a Daniell cell, which is, hence^ 
convenient as a standard of comparison. The unit of resistance is the 
ohm, so named from the discoverer of the celebrated law. The unit 
of intensity is the ampere, formerly the weber, both the names of 
physicists, distinguished in electrical science. An ampere represents 
the quantity of electricity produced by the unit of electro-motive force 
— the volt — circulating in a conductor having the unit of resistance — 
the ohm — during the unit of time — the second. It has been practically 
ascertained that this is the quantity of electricity furnished by a Daniel! 
cell, and made to pass through a hundred metres of telegraph-wire. 
The unit of capacity is the farad, from Faraday ; but, as this amount 
is much too large for medical purposes, it is the usual practice to em- 
ploy the term microfarad, which is equal to one millionth part of a 
farad. 



ELECTRICITY. 



367 



There are several modes of ascertaining the current strength. The 
voltameter (Fig. 8) is an instrument for collecting the oxygen and 
hydrogen produced by the decomposition of water. The quantity of 
gas per minute evolved by the gal- 
vanic action is an absolute measure 
of the strength of the current dur- 
ing that time. This instrument, 
although not so much used as the 
galvanometer for determining cur- 
rent strength, is not without prac- 
tical utility, and it is employed by 
Ciniselli and others to ascertain the 
power of any given combination be- 
fore proceeding in the operation of 
electrolysis in the treatment of aneu- 
rism. Galvanometers are more frequently used. A galvanic current 
made to traverse a wire, in the vicinity of a magnetic needle, deflection 
takes place according to the strength and direction of the current. 
This constitutes the simplest form of the galvanometer. It is really a 
galvanoscope, indicating the existence of a current and its direction, 
but not affording an exact measure of its strength. The astatic com- 
bination is much more sensitive : it consists of two needles of about 
the same strength, but placed in opposite positions as to polarity, so 
that the directive force of the earth's magnetism is neutralized (Fig. 9). 
The arrangement of an astatic galvanometer is shown in Fig. 10. To 




Fig. 8.— Voltameter. 



6 




i 





Fig. 9.— Galvanometer. 



Fig. 10.— Galvanometer. 

render such a galvanometer of use as a means of exactly representing 
the strength of the current, the scale must be graduated in mille-am- 
peres of absolute measurement, or millewebers. Such instruments, as 
now made, enable the operator to express in exact terms the current 



368 EXCITO-MOTORS. 

strength ; instead of the number of cups, which affords so inexact a 
measure, the absolute galvanometer interpolated in the circuit, indi- 
cates in mille-amperes, or millewebers, the actual strength. In the 
present condition of this subject, it has become necessary to express 
in an exact way the current strength, just as medicines are carefully 
weighed. * 

The mode of combining the cells of a galvanic battery is determined 
by the purpose to which it is to be applied. The circuit may be " sim- 
ple " or " compound." In the former, the elements are united zinc to zinc 
and copper to copper, so that in a battery of twenty cells so united there 
is one large zinc and one large copper element, and the resistance is at 
the minimum, the chemical action yielding a very considerable quantity 
of electricity, the most of which is available. In the compound circuit 
the battery elements are arranged in series, the zinc of one connected 
with the copper or carbon of the next, and so on throughout the whole 
number. As every conductor opposes some resistance to the passage 
of the current — in other words, there is no perfect conductor — there 
must be considerable loss of electricity. It is sometimes said that the 
quantity of electricity is determined by the size of the zinc plates acted 
on, and that intensity is the result of combining numbers of elements. 
It must be understood that intensity is the power to overcome resist- 
ance, and as the resistance offered by the human body is enormous, it 
follows that a battery for the medical application of galvanism must 
have numbers rather than size. Those battery-cells furnish the smooth- 
est current in which the internal resistance is about equal to the resist- 
ance of the human body. The zinc-carbon elements of Stohrer cause 
considerable irritation and burning, while those of Siemens and Halske 
are smooth and bland. The most experienced electricians use the 
latter for this reason. It follows, therefore, that all those devices in- 
tended to diminish internal resistance are not to be commended in gal- 
vanic batteries for medical use, how desirable soever they may be in 
batteries for economic purposes. In galvanic batteries intended for 
transportation, every consideration, except efficiency, must be sacrificed 
to portability, and various mechanical arrangements have been made 
to combine these qualities. In the Stohrer, Gaiffe, and chloride-of- 
silver batteries, the safe transportation of the cells is insured, but the 
current of such combinations is wanting in the uniformity and smooth- 
ness which are such important qualities in the permanent batteries. 

The performance of any galvanic combination may be readily as- 
certained by the law of Ohm. The intensity is directly proportional 
to the electro-motive force, and inversely proportional to the resist- 
ance encountered within the cell and on the circuit. This law is rep- 
resented in the following formula : 

R + r 



ELECTRICITY. 369 

I is the symbol for intensity, E for electro-motive force, R for internal 
resistance (in the cup), and r for external resistance (on the circuit). 

E 

Or it may be stated that R = -~ ; that is to say, the resistance equals 

the electro-motive force divided by the current. The term electro- 
motive force merely means the difference in potential between the two 
poles. 

A battery, whether portable or permanent, requires a "pole-board" 
for its working. An ordinary battery of a few elements may be manip- 
ulated by a simple sliding selector and polarity changer, such as that 
now attached to the Stohrer portable arrangement ; but the permanent 
batteries of large size, such as are now employed for the office and con- 
sultation rooms of medical electricians, require more efficient arrange- 
ments. The battery of 60 to 100 elements placed in the cellar or some 
distant closet, is connected, in groups of cells, with the pole-board. 
By means of the selector, any desired number of cells can be put in 
the circuit. The pole-board should also be supplied with a current- 
changer, a rheostat, an interrupter, and resistance-coils. A water rhe- 
ostat suffices for ordinary purposes. As water is an indifferent con- 
ductor, it follows that the galvanic current has a degree of difficulty 
in passing through it ; hence, any amount of resistance can be interpo- 
lated in the circuit. The most accurate mode of introducing a meas- 
urable resistance is the resistance-coil. This is made of German-silver 
wire of a certain length and cross-section. The resistance offered by 
such a wire to the passage of the current is directly as its length, and 
inversely as its sectional area ; that is, the longer the wire, and the less 
its size, the more the resistance to the transmission of the current. 
The unit of resistance, the ohm, is the resistance made to one volt by 
a wire two hundred metres in length. It is obvious that any number 
of ohms in resistance can be interpolated in the circuit. Resistance- 
coils of definite measures of resistance are now added to each properly 
equipped pole-board. They are especially necessary in applications of 
galvanism by the polar method. 

Faradism, or Electro-Magnetism and Magneto-Electricity. 

Faradism, so named in honor of Faraday, is induced electricity. 
When the galvanic current passes through the conjunctive wire of the 
elements of a cup, especially of a battery, it acquires new properties — 
acts on a magnetic needle, and exhibits the other properties of a mag- 
net. When the conjunctive wire is extended into a coil, coated with 
insulating material, it will act on another coil in its neighborhood, as it 
does on a magnet. The former is called the primary or inducing coil, 
and the latter the secondary or induction coil. If the latter is con- 
nected with a galvanometer, it will be found that when a current trav- 
erses the primary coil, the needle of the galvanometer is at once 

24 



370 



EXCITO-MOTORS. 



deflected ; but if the current continue to pass without any variations 
in the tension, the needle presently conies to rest. When the current 
is broken or interrupted, the needle is again deflected, but this time 
in the opposite direction. It follows, therefore, that the induced cur- 
rent only occurs at the opening and closing of the primary circuit : at 
the making or closing the circuit, in the opposite direction ; and at the 
opening or breaking of the circuit, in the same direction. The induced 
or faradic current is therefore a to-and-fro current, instantaneous in 
duration. It is obvious from these considerations that in the construc- 
tion of a faradic battery there must be a mechanical arrangement for 
interrupting the current in the primary circuit. The usual automatic 
interrupter is Neef's hammer, a vibratile steel spring worked by the 
magnetism of the soft-iron core. The best instruments are now pro- 
vided with a simple mechanism to give slow interruptions, an impor- 
tant matter when muscles are to be exercised. In the purchase of a 
faradic instrument for medical purposes the device to effect the slow 
interruptions should not be overlooked. 

The galvanic couplet for the primary coil is now almost always the 
zinc-carbon combination excited by bichromate solution.* The pri- 
mary or inducing coil is made of thick wire and is much shorter than 
the secondary coil. In the interior of the primary coil is placed a 
bundle of wires, each one insulated and becoming a magnet when the 
current passes. This temporary magnet attracts the hammer of the 




Fig. 11.— Ruhmkorff Coil,. 

vibrator, and on the instant the current is closed and opened again. 
The so-called primary current of the faradic battery is therefore some- 

* The bichromate solution is prepared as follows : Dissolve one ounce of bichro- 
mate of potassium in eighteen ounces of hot water in an earthenware vessel. Let 
it cool, and when cold add two fluid ounces of sulphuric acid, and two drachms of 
nitric acid. It should not be used until cold, and it is, therefore, preferable to keep it 
on hand. 



ELECTRICITY. 



371 



thing more than that coming from the galvanic couplet ; it is re- 
enforced by the induction between the turns of the coil and by the 
magnetism of the soft-iron core. 

The coil of induction, or the secondary coil, is made of long and 
fine wire ; the longer and finer, the more intense the current. The 
Ruhmkorff coil, which is composed of miles of very fine wire, fur- 
nishes a brilliant spark sometimes several inches in length (Fig. 11). 

Electro-magnetism is the title of that mode of the force induced 




Fig. 12. 

by the action of a galvanic current on a bundle of wires within an 
insulated coil ; in other words, it is the ordinary faradic battery, ex- 
cited by a galvanic couplet (Fig. 12). Magneto-electricity ', on the 
other hand, is that mode of the force induced by the action of a per- 
manent magnet. If we substitute for the cell 
a strong permanent magnet, we learn that, 
on the approach or withdrawal of . the magnet 
from a coil of insulated wire, a current of elec- 
tricity is induced in the coil : on the approach 
of the magnet, in one direction ; on its with- 
drawal, in the opposite direction (Fig. 13). Thus 
an instantaneous to -and -fro current may be 
caused by the action of a magnet, just as by 
the action of a galvanic current. Out of this 
principle has developed the magneto-electric 
machine, which consists of the permanent mag- 
nets, insulated coils made to revolve about the 
poles, and a mechanical arrangement for ob- 
taining regular revolutions, and making and breaking the circuit. 
Thus, by mechanical power, the same results are produced as by 
chemical action (Fig. 14). 

The discovery of a simple commutator, by which the currents can 




Fia. 13. 



372 



EXCITO-MOTORS. 



be collected and sent in one direction, has quite revolutionized the 
utility of this form of battery. It is now applicable to electric decom- 
position (electrolysis), to electric heating (galvano-causty), and electric 




Fig. 14.— Magneto-Electric Machine. 



lighting. Indeed, with the general use of electricity furnished by the 
" dynamo-machines " as a motive power, it is probable that the force 
in this form will be successfully applied to medical purposes. 



Electro-Physiology. — Much of the supposed knowledge of this sub- 
ject is in a transition state, and will ultimately require very different 
statement. Into this doubtful region the author will not enter ; but 
there are facts of great value which should not be overlooked. 

Action of Galvanism on Motor Nerves and Muscles. — Whether a 
muscle be acted on directly by a galvanic current, or indirectly through 
a motor nerve which supplies it, the muscle is thrown into action ; but 
the action is limited to the opening and closing of the circuit if the 
tension of the current continues the same throughout. If the "de- 
scending " or " direct " current has the minimum strength to cause a 
muscular contraction, this will take place at the closing of the circuit 
only, and there will be no action at the "opening," or "interruption," 
or " breaking " of the circuit. A descending, closing-current muscu- 
lar contraction is always greater than the opening. The rule is differ- 



ELECTRICITY. 373 

ent in the case of the " ascending " or " indirect " current. The feeblest 
strength of current, passing in the inverse direction, which will cause 
a muscular contraction, induces it only at the opening of the circuit, 
but, if a strong current is used, both at the opening and closing. Di- 
rect excitation of a muscle by galvanism causes more powerful mus- 
cular contractions than indirect. Such are the results of galvanic 
stimulation when the motor nerves are uncovered by tissues, and are 
directly acted on by the electrodes. If, however, motor nerves and 
the muscles are acted on through the tissues covering them, the most 
energetic contractions are induced by inverse or ascending currents, 
and at the closing of the circuit. When a motor nerve supplies by 
separate filaments two muscles, stimulation of one filament causes con- 
traction of the muscle to which it goes, but contraction of the other 
muscles also takes place. To the latter is applied the term induced 
contraction. If a motor nerve is stimulated again and again by a 
direct current, finally its excitability — that is, its power to contract on 
irritation — is exhausted ; then the excitability may be restored by the 
action of an inverse current. By thus alternating in the direction of 
the current, the muscular irritability may be alternately destroyed and 
restored for a long time, if not indefinitely. To these phenomena 
has been applied the term voltaic alternatives. 

Action of Faradism on Jfotor Nerves and Muscles. — A faradic 
current, whatever its direction, stimulating a motor nerve, causes con- 
traction of the muscles innervated by this nerve. If the interruptions 
in the primary circuit are slow, the muscles have time to contract and 
relax ; but when the interruptions are rapid, the muscles are kept in 
a condition of tonic contraction, or are tetanized. Long-continued, 
powerful faradic stimulation of a motor nerve exhausts its irritability. 
Muscles directly acted on by a faradic current contract energetically, 
but repeated over-stimulation will fatigue and ultimately destroy their 
contractility. When, however, muscles are in this condition of fatigue 
and exhaustion, from faradic stimulation, their proper functional state 
may be restored by passing a continuous galvanic current through 
them. If not too long applied or too powerful in action, faradic ap- 
plications improve the nutrition of muscles, and through this increased 
activity of the circulation there occurs a rise of temperature, generally. 

TJie Polar Method as applied to the Beactions of Motor Nerves and 
Muscles. — This important method of examining the condition of motor 
nerves and muscles must be understood, to rightly appreciate the 
modern mode of electro-diagnosis. As certain terms, having technical 
meanings, are much used in this connection, it is necessary to define 
them before proceeding to describe the phenomena. Anode is the 
term applied to the positive pole, cathode to the negative pole, and 
the adjectives, anodal, relating to the anode, and cathodal, relating to 
the cathode. As the polar method had its origin in Germany, the 



374 EXCITO-MOTORS. 

symbols now used to indicate electrical reactions are taken from Ger- 
man words. Charcot in France, Buzzard in England, and the Ameri- 
can writers in general, have adopted the German formulae, so now 
their use is universal. 

The polar method consists in exciting nerve or muscle with one 
pole, while the other rests on some indifferent spot, as the sternum, as 
advised by Erb. We are here concerned with the normal or physio- 
logical state ; hereafter, the pathological conditions will be given. 
The normal formulae consist in the reactions which ensue on polar 
stimulation, nerves and muscles being healthy. When the current is 
closed by applying the cathode to the nerve or muscle to be excited, 
the symbols are Ka S (Ka, Kathode ; S, Schliessung, closing). When the 
current is opened or broken by removing or disconnecting the cathode, 
the symbols are Ka O (Oeff?iung y opening). Corresponding symbols 
are used in respect to the anode. Thus, the words anodal closing are 
An S, and anodal opening, An O. To express muscular contraction 
the symbol is Z (Zuckung) ; a strong contraction is Z' ; for a weak 
contraction, z, and for a tetanic contraction, Te. In the physiological 
state, the muscular contractions as induced by the polar method are 
characteristic, and can be expressed in the symbolic language now 
employed for the purpose. It is to be observed, in the first place, that 
the cathode or negative pole has more power to induce muscular action 
than the anode or positive pole. 

The cathode has more effect on closing the circuit ; whereas the 
anode acts more powerfully on opening or breaking the circuit. 

The normal formulae of muscular contractions induced by the polar 
method may be arranged in three grades : 

In the first grade, the weakest current having power to induce any 
contraction causes it on cathodal closing — whence the formula Ka 
S Z ; and no action takes place from the anode. 

In the second or intermediate grade, the strength of current is 
sufficient to cause strong cathodal closing contraction (Ka S Z ; ), but no 
opening contraction ; whereas, on anodal opening and closing there 
are feeble contractions — whence An S z, and An O z. 

In the third grade, which is the highest, the current causes on 
cathodal closing a tetanic contraction, Ka S Te, and a feeble contrac- 
tion on cathodal opening Ka O z ; whereas, there occur decided con- 
tractions on anodal opening, An O Z, and on anodal closing, An S Z. 

Such are the normal formulae — such is the normal behavior of 
muscles ; but in disease, as we shall subsequently learn, these formulae 
may be much changed, may be even entirely reversed. 

Action of Galvanism on No7i-striated Muscles. — The physiologi- 
cal differences in the action of voluntary and organic muscular fibers 
are well exhibited in the results of galvanic stimulation. Instead of a 
prompt, almost instantaneous muscular contraction, characteristic of 



ELECTRICITY. 375 

the voluntary fiber, a slow vermicular motion is set up in the involun- 
tary, and this movement is propagated from the point of stimulation 
by a rhythmical action. 

Action of the Galvanic Current on the Brain and Spinal Cord. — 
Until the experiments of Fritsche and Hitzig, Ferrier, Nothnagel, 
and others, within a few years past, the electric excitability of the 
brain had not been admitted. It seems now to be established that 
certain areas of the cortex cerebri are anatomically associated with 
certain muscular groups. These facts have been ascertained by direct 
stimulation of these areas of the cortex by galvanic (Fritsche and 
Hitzig) and faradic (Ferrier) applications. Can the intra-cranial or- 
gans be reached through their investing tissues ? This is the most im- 
portant question, and to this, fortunately, we are able to reply in the 
affirmative. Erb was the first to prove the transmission of a galvanic 
current through the brain, and now the fact is universally admitted. 

On electric stimulation of the cord, results are produced accord- 
ing to the functional powers of the part — pain when the sensory tract 
is irritated, and muscular movements when the motor is acted on. 
Hence, the statement of Erb, that these effects may be due to stimula- 
tion of the nerve-roots, has a high degree of probability. In the spi- 
nal cord, as in the nerves, the inverse or ascending current causes more 
decided effects. 

Electric excitation of that part of the cord between the fifth cervi- 
cal and tenth dorsal vertebrae causes dilatation of the pupil, whence 
this region is known as the cilio-spinal region. The explanation of 
this fact is, that in this part of the cord originate filaments of the 
sympathetic, connected with the cervical ganglia. In the lumbar part 
of the cord is a similar center, related to the genital apparatus, and 
hence called the genito-spinal region. 

Action of the Galvanic and Faradic Currents on the Pneumogas- 
tric. — A weak galvanic current sent through the pneumogastric, in- 
creases the force and rapidity of the heart's movements ; but a strong 
current arrests the heart in the diastole. After division of the nerve, 
stimulation of its upper or central portion arrests respiration in the 
movement of inspiration, but does not influence the heart ; but a 
strong current acting on the lower or distal portion of the nerve stops 
the heart in diastole. A descending galvanic current, passed through 
the pneumogastric nerve, suspends the contractions of the stomach. 
A faradic current directly applied to the pneumogastric, before and 
after division of the nerve, produces the same results, but more decid- 
edly ; applied through the tissues, it has no apparent effect. 

Action of Galvanism and Faradism on the Sympathetic System. — 
Covered by the tissues, the ganglia and fibers of the cervical sympa- 
thetic are not acted on by faradic and static electricity, but even a 
weak galvanic current does affect them. Applied directly to the sym- 



376 EXCITO-MOTORS. 

pathetic nerves, the effect is tetanizing, and the vessels receiving their 
innervation from this source contract very strongly. Applied through 
the tissues, the faradic current has little or no effect. 

The kind of action set up by galvanism, and the differences due to 
the direction in which the current is passing, have been much disputed. 
The author believes that the experiments and the deductions of Oni- 
mus and Legros correctly represent the actual condition. They hold 
that the direct or descending current, by increasing the normal wave- 
like or vermicular motion of the muscular layer of the vessels, increases 
the amount of blood passing through them, and that the inverse or 
ascending current, by diminishing the vermicular movement, lessens 
the quantity of blood. 

Electro-Diagnosis. — For diagnostic purposes both galvanic and 
faradic currents are necessary. The polar method has been applied with 
great success for determining the condition of nerve and muscle. As 
has been stated, the pole intended for excitation must be placed over 
the nerve or muscle to be acted on, while the other rests on some in- 
different point — for the upper extremity and trunk, the sternum is 
convenient. If the operator has no assistant, an interrupting handle 
of the electrode is useful, or an automatic interrupter may be attached 
to the pole-board, or the interruptions may be effected by simply ap- 
plying or removing the electrode. 

The normal formulae of nerve and muscle actions have been set 
forth ; in disease these formulae are altered — may be, even entirely 
reversed. It suffices now to state that when a faradic — an induced — 
current is applied to a muscle, or to the motor nerve supplying it, con- 
traction of the muscle takes place. This is called faradic excitation, 
and it is direct when the contraction is caused by application of the 
electrodes to the muscle itself, and indirect when the motor nerve is 
acted on. When galvanism is used to produce these effects, the term 
applied is galvanic excitation, and this is direct or indirect. 

The Diagnosis of Paralysis. — When the paralysis is limited to a 
group of muscles, to one member, or to one side, the behavior of the 
paralyzed muscles is compared with the normal. If, however, as is 
comparatively infrequent, symmetrical muscles are paralyzed, their 
condition must be contrasted with that of another healthy subject. 

The paralysis of muscles may be complete, and yet they react in a 
normal manner. In other cases, there may be merely quantitative 
changes ; that is, there is a mere increase or diminution of electric 
excitability, the polar reactions conforming to the normal, in order. 
In the third group, the paralyzed muscles are found to be changed, 
not only quantitatively but qualitatively, in respect to their responses 
to the electrical excitation. If the muscles respond in a normal man- 
ner to both forms of current, it may be concluded that the spinal cord 
connected by nerve-fibers to the paralyzed part is free from disease. 



ELECTKICITY. 377 

The changes in respect to the electric excitability, in some cases of 
paralysis, consist merely in a quantitative increase to both currents : 
the muscles react to a less strength of current, or more energetically 
to the same strength. In the latter, while the normal formula is de- 
veloped by acting on the healthy muscles, on the paralyzed side the 
reaction is more decided, as indicated by a cathodal closing contrac- 
tion (Ka S Z) occurring with a very weak current, or Ka S Z becoming, 
on the application of the same current, a tetanus (Ka S Te) ; also indi- 
cated by the early appearance of an anodal opening contraction (An O Z) 
and the prompt appearance of a cathodal opening contraction (Ka O Z). 
A hemiplegia of recent occurrence, some cases of spinal paralysis at 
a very early stage, and very rarely the earliest manifestations of pa- 
ralysis from nerve-lesions, are illustrative of this state. 

The usual condition for which the electrical currents are employed 
in diagnosis is diminution or loss of electric excitability. Spinal, 
motor-nerve, and muscular lesions are the most important. " Reac- 
tions of degeneration " is the happy term employed by Erb to signify 
the changes in the electrical reactions. Owing to disease of the cord, 
or of the motor-nerve trunks, degenerations of tissue ensue, and hence 
the term. For a very brief period, in some cases, there is an increase 
of electrical excitability, but a decline then quickly ensues. As re- 
gards faradism, the strength of current necessary to cause a contrac- 
tion of the affected muscles must be constantly increased, and in a 
short time no strength of current will cause the least movement. The 
normal formula for the galvanic current is changed, pari passu, with 
the decline of faradic excitability. First, the cathodal closing tetanus 
ceases (Ka S Te), then anodal closing contraction (An S Z), and finally 
cathodal closing (Ka S Z) can be excited only by the strongest cur- 
rent. These changes represent a gradually increasing atrophy of the 
muscles, and the final cessation of the cathodal closing contraction 
signifies an extreme degree of atrophy, and the disappearance of the 
muscular elements. 

In the condition known as the reactions of degeneration, it is im- 
portant to distinguish between the reactions of the motor nerve and of 
the muscles. It has been already pointed out that, whether the mo- 
tor nerve supplying it, or the muscle itself is acted on, muscular con- 
tractions take place. In the changes which ensue in cases of paralysis, 
the state of the nerve is separable from that of muscle. If the paral- 
ysis is due to a lesion of the nerve-trunk — to an inflammation of the 
nerve, for example — there may be a brief period when, as above stated, 
the electric excitability is heightened ; but, as the nerve undergoes de- 
generative atrophy, there ensues a quantitative decline in the response 
to electrical excitation, to both faradic and galvanic, and by the twelfth 
day, sometimes earlier, it has usually entirely disappeared, if the le- 
sions have proved destructive and irremediable. On the other hand, 



378 EXCITO-MOTORS. 

\ 
if the injury done is less, and is remediable, the electric excitability is 
modified only, and not lost. When recovery from the injury, or in- 
flammation of the affected motor nerves takes place, the muscles inner- 
vated will respond to the impulses of the will, long before they react 
to faradic or galvanic stimulation. 

When the spinal cord is the seat of disease, as in infantile paralysis, 
glossolabiolaryngeal paralysis, progressive muscular atrophy, etc., the 
paralyzed nerves and muscles exhibit most characteristic electrical re- 
actions. As regards the motor nerves, in two or three days, usually, 
after the paralysis has manifested itself, a regular and steady quanti- 
tative decline in excitability to both forms of current takes place, and 
by the end of the second week, usually, and sometimes by the end of 
the first week, no strength of current applied to the nerve will cause 
muscular contractions. At first, cathodal closing ceases, then anodal 
closing, and finally anodal opening. 

The muscular reactions are much changed from the normal. The 
muscles, in about a week after the paralysis appears, begin to decline 
in their excitability to the faradic current, and, at the end of two 
weeks, it is totally lost, and they cease to respond to any strength 
of application. If regeneration of the diseased nerve-tissue can be 
effected, restoration of the faradic excitability may be accomplished, 
but to a less extent than before. 

The phenomena connected with the galvanic excitability are very 
different. For the first week of the paralysis the response of the mus- 
cles to the galvanic current declines, as it does to the faradic ; but, 
after the second week, a remarkable change ensues : then the galvanic 
excitability begins to increase, and with this there occur qualitative 
changes in the order and mode of muscular contractions. These con- 
sist in a gradual increase of the anodal closing contraction, which soon 
equals if it does not surpass the cathodal closing, and the cathodal 
opening contraction declines in the same measure. In other words, an 
actual reversal takes place of the normal formulae. If the degenera- 
tions continue, and the muscular elements are finally destroyed, the 
reactions ultimately cease, the last to disappear being a very feeble 
anodal closing contraction. Such are the reactions of degeneration. 
They occur in cases of spinal paralysis, when the disease in the cord 
is in direct anatomical association with the paralyzed parts, and in 
cases of peripheral paralysis when due to injury or disease of nerve- 
trunks. The so-called infantile paralysis is an illustration of the for- 
mer, and facial paralysis of the latter. When the disease is situated 
in the cord above the point from which nerves are given off to the 
paralyzed members, there is no change in the law of muscular contrac- 
tion. When, for example, a transverse myelitis exists entirely above 
the dorso-lumbar enlargement of the cord, the muscles of the lower 
extremities, although paralyzed, react normally to the faradic and 



ELECTRICITY. 379 

galvanic currents. Again, in disseminated myelitis there are groups 
of muscles that react in accordance with the law of normal contrac- 
tion, and other groups that manifest the reactions of degeneration — 
the former being in anatomical connection with a healthy part of the 
cord ; the latter with a diseased area. It follows, therefore, that a 
proper electrical examination should be made as a means of diagnosis 
in the diseases of the nerve-centers. 

Diagnosis of Sensibility. — By means of the faradic brush, and 
pointed electrodes closely approximated, the state of sensibility of the 
skin may be readily marked out. The skin must be carefully dried 
to prevent diffusion of the current, and then the brush or electrodes 
conveying the induced current must be carefully passed over the sup- 
posed anaesthetic and analgesic area, and the outlines of the affected 
surface thus ascertained. 

The galvanic current by the polar method has been very success- 
fully applied to determine the state of the auditory nerve. The pole 
intended for excitation is introduced through a suitable non-conduct- 
ing speculum into the ear, previously filled with warm water, and the 
other pole is placed on the mastoid process, nape of the neck, or any 
indifferent point. Brenner, of St. Petersburg, who has contributed 
the most of the exact knowledge now in our possession regarding these 
auditory reactions, has invented resistance-coils to be utilized in these 
researches. A strong current, reduced to the necessary point for act- 
ing on the auditory nerve by the introduction of sufficient resistances, 
is passed through the organ, and the resulting sounds, subjective, and 
audible, of course, only to the patient, indicate the condition of the 
nerve. These sounds, whistling, singing, roaring, etc., have been re- 
duced to formulated expressions. Although there are differences of 
opinion in regard to the real value of these auditory reactions, it seems 
to be now well established that Brenner's method and formulae are 
correct in the essential details. 

The state of gustatory sensibility is most correctly ascertained by 
galvanic stimulation of the end-organs of the nerve. For this purpose 
a pointed electrode, the positive and negative as closely approximated 
as possible, is carefully passed over the area of distribution of the sense 
of taste, and its condition noted. 

Feigned paralysis may sometimes be detected by faradic stimula- 
tion of the muscles, and feigned insensibility by a strong current. 
Hysterical paralysis is remarkable for the absence of electro-sensibility 
and the presence of electro-contractility. 

Therapy. — Manipulation. — Electrodes for the application of gal- 
vanism or faradism are of various shapes and materials. The best, 
probably, is a disk of carbon covered with wash-leather. A metal 
disk covered with soft sponge is also much used. The size depends 
on the purpose to which applied. When large volume and high in- 



380 EXCITO-MOTORS. 

tensity are the qualities of the current, the electrode should be of large 
size, of soft sponge, well moistened. For application to small muscles, 
Duchenne's olive-shaped, curved electrodes are most suitable ; and to 
individual nerves, metal buttons of various shapes covered with wash- 
leather. The instrument-makers are now supplied with all forms and 
kinds of electrodes, so that the operator can always obtain what form 
of electrode soever he may desire. 

When it is intended to act on parts beneath the skin, the electrodes 
and skin should be well moistened, for the conductivity of the tissues 
is in direct ratio with the amount of water they contain. On the other 
hand, if the skin alone is to be acted on, it should be well dried to pre- 
vent diffusion of the current. When weak galvanic applications are 
made, but little tingling is felt by the patient, and hence he may sup- 
pose that no curative effect is produced. Under such circumstances, 
it were better to add a little salt to the water with which the electrodes 
are moistened. 

Electrical applications should always be made to the affected part, 
and also to those parts in which decided symptoms are felt. The 
principle of localized electrization, as established by Duchenne, was a 
most important advance. Next, the polar method did much to give 
exactness to methodical applications. When the poles have a fixed 
position, and are not moved, the application is said to be stabile, and, 
when moved over the part operated on, labile. If the direction the 
galvanic current is taking is parallel to the nerve-current, or from the 
center toward the periphery, the application is said to be direct, or 
descending ; if in the opposite direction, indirect, or ascending. 

General electrization is a term used to indicate the application of 
either current to the whole surface of the body — one pole placed on 
the nape of the neck, or to the feet, and the other passed over the 
whole surface of the body. Centred galvanization is a term invented 
by Beard and Rockwell to signify applications to the cervical sym- 
pathetic, to the pneumogastric, to the cervical and dorsal parts of the 
spinal cord, and to the solar plexus. If one pole be placed on the 
seventh cervical vertebra, and the other in the fossa behind the angle 
of the jaw ; if the former be kept in this position, and the latter put 
on the epigastrium ; and, lastly, if the first be moved down the spine 
to a point opposite the second — there will be brought into the circuit, 
successively, the ganglia of the cervical sympathetic and their cardiac 
branches, the pneumogastric, spinal accessory, phrenic, the semilunar 
ganglion and solar plexus, and the spinal cord. 

In what mode soever applied, and at what point, more or less dif- 
fusion of the current takes place. Although the current flows from 
the higher to the lower potential by the most direct route, a greater 
or less deflection is caused (diffusion) by the resistance encountered on 
the circuit. 



ELECTRICITY. 381 

Magneto-Therapy. — The force furnished by the magnet — mag- 
netic polarity — produces distinct effects when applied to plants and to 
animals, and it has been utilized in the treatment of diseases. It has 
been shown by Dr. Vansant that the south pole of the magnet ap- 
plied to a sensitive surface causes pain, while the north pole is free 
from this action, and indeed relieves the pain caused by the former. 
Small animals are similarly affected, the south pole causing excite- 
ment, and the north pole sedation. Sometimes remarkable curative 
results are obtained by the application of magnets in neuralgia and 
in chorea ; but they often fail utterly. In hysterical affections, hemi- 
anesthesia^ contractures, etc., the results are more constant, and, in- 
deed, are often very striking. It is quite impossible to separate the 
influences due to the imagination from the direct action of the magnet. 

The form of magnet used in medical practice is chiefly the horse- 
shoe, and, to obtain sufficient power, several permanent magnets are 
clamped together. The magnetic pole with which the effect is in- 
tended to be produced may be gently stroked along the course of the 
nerve in cases of neuralgia, or the magnet may be fastened on the part 
by suitable straps. The duration of the application will be determined 
by the effects. In some cases the result is little short of magical ; in 
others, apparently of the same character, no effect follows. 

Galvano - Therapy. — The most important curative results are 
wrought by galvanism. As a rule, the large, two-fluid elements of 
the permanent battery are much more effective therapeutically than 
the small portable combinations. In the Siemens and Halske modifica- 
tion of the Daniell cup, which is so much employed by German electro- 
therapeutists, and which the author also uses, the resistance within 
the battery is very great, nearly equal, indeed, to the resistance of the 
body. Hence, the current is smooth and uniform, and hence, also, the 
good results obtained from it. 

Allbutt made a number of experimental observations at the West 
Riding Lunatic Asylum on the therapeutical effects of electricity (gal- 
vanism) in psychical disorders, and he sums up his results as follows : 
Marked improvement in acute primary dementia ; distinct improve- 
ment in mania, atonic melancholia, and perhaps recent secondary de- 
mentia ; no change observed in chronic dementia and some cases of 
melancholia, and an unfavorable effect in hypochondriacal melancholia, 
and perhaps brain-wasting. In the cases reported by Allbutt, the cur- 
rent was sent through the head and through the cervical sympathetics. 
Benedict (page 222) reports three cases of mental disorder improved 
by galvanism. 

I have observed excellent results in the mental and other symp- 
toms — confusion of mind, impaired memory, hypochondriasis, vertigo, 
etc. — which result from imperfect nutrition of the brain, caused by 
atheromatous degeneration of the cerebral vessels. My method of 



382 EXCITO-MOTORS. 

application has consisted in transverse transmission of galvanism 
through the brain, using a current of sufficient intensity merely to 
cause slight giddiness, a faint metallic taste, and barely perceptible 
flashes of light. 

Galvanization of the brain and of the cervical sympathetics is one 
of the measures to be resorted to in acute active or passive congestion 
of the brain. Wakefulness, when not reflex in origin, and when de- 
pendent simply on the state of the vascular supply, is often relieved 
by galvanization of the brain. Insomnia may be dependent on either 
active or passive congestion. In the first case a continuous current of 
moderate intensity should be passed through the superior ganglion of 
the sympathetic — the positive pole being placed in the auriculo-max- 
illary fossa, the negative on the seventh cervical vertebra ; in the 
second case a mild current should be transmitted transversely through 
the brain, and be slowly interrupted. 

To promote absorption of the clot in cases of cerebral hemorrhage, 
and to relieve the collateral oedema in embolism of the cerebral arte- 
ries, very mild galvanic currents may be employed. Caution is neces- 
sary, however, in employing galvanism in such cases. Strong currents 
and lengthened applications may do serious mischief ; but the author 
believes, with Remak, that judicious application of galvanism will be 
useful. The immediate effects of the embolism, or of the haemorrhage, 
should be allowed to subside before commencing the use of electricity, 
and, if there be much headache and vertigo, the greatest circumspec- 
tion will be necessary. 

In hemiplegia the constant current may be applied to the brain, 
for the purpose of improving its nutrition, and the faradic or induced 
current to the muscles, to prevent wasting and loss of function from 
disuse. If the temperature of the paralyzed parts is lowered, the skin 
discolored and roughened, the muscles weak and flabby, much im- 
provement in all these particulars will follow faradization. Large elec- 
trodes, well moistened, should be used, and all the muscles should 
in turn be made to contract — one pole being placed over the motor 
nerve, the other over the bellies of the affected muscles. In cases of 
hemiplegia, when the nutrition of the skin and muscles has been im- 
proved to the extent which faradization can accomplish, no advantage 
can accrue from further persistence in the applications. In faradizing 
the muscles in a case of hemiplegia, a current of just sufficient inten- 
sity to cause contractions should be used. Tetanic cramps fatigue the 
muscles, and are harmful. The so-called " late rigidity " — the muscu- 
lar contractions which ensue after a time in hemiplegia, and which 
occur chiefly in the forearm and hands — is best treated by a contin- 
uous current to the contracted flexors, and an interrupted or faradic 
current to the relatively weaker extensors. 

In recent affections of the spinal cord, as a rule, electricity is not 



ELECTRICITY. 383 

indicated. In chronic myelitis, syphilitic diseases of the meninges, 
after a course of suitable speciiic treatment, and in some of the sequelae 
of acute meningitis, much good may be accomplished by the galvani- 
zation of the spine and the paralyzed muscles. The wasting of the af- 
fected muscles may be arrested and their nutrition raised to the nor- 
mal, and the paralysis of the sphincters may, in many cases, be relieved. 
When the electro-contractility of the muscles is not impaired, and 
when they have not wasted, no good is to be accomplished by stimu- 
lating them with the electrical current. 

That very troublesome disorder, spinal irritation, with its extensive 
irradiations of nerve-pain, is much benefited by an inverse galvanic cur- 
rent, according to Hammond, and this observation I have been enabled 
to confirm by my own experience. Hysterical paralysis of the extremi- 
ties, accompanied or not with anaesthesia or hyperaesthesia, should be 
treated by galvanization of the spine and faradization of the muscles. 

In paralysis from lead (dropped wrist), the muscles may be so far 
atrophied as not to respond to faradization, but may react when stimu- 
lated by a slowly-interrupted galvanic current. When this condition 
exists, the interrupted galvanic current must be first employed, and the 
cure be completed by the faradic current when the muscles are so far 
improved as to react to the latter. 

The best example of & peripheral paralysis is that of the muscles 
of the face, from disease or injury of the facial nerve. From exposure 
to cold, or disease of the ear, or traumatic injury, the nerve is damaged, 
and the muscles to which it is distributed are paralyzed. In accordance 
with the law already given, such muscles do not respond to the faradic 
current, but do react to galvanism. The positive pole is placed over 
the pes anserinus, or on the mastoid process, and the negative is made 
to pass over the peripheral expansion of the nerve, so that all the mus- 
cles innervated by the nerve are brought into action. A current of 
sufficient intensity to induce muscular contraction must be employed. 
As in the case of other peripheral paralyses, after a time the af- 
fected muscles recover their power of response to faradism, when this 
form of current may be used to complete the cure. If the nerve has 
not been irremediably damaged, and if the paralysis has not existed 
so long that the electro-contractility is lost in consequence of atrophic 
degeneration of the muscles, a cure of facial paralysis may be effected 
by a persistent use of electricity. 

Certain of the ocular paralyses, as of the third, fourth, and sixth 
nerves, are often cured by electricity (interrupted galvanic current). It 
is necessary, in order to obtain a successful result, that the remedy be 
employed in suitable cases. When these paralyses are dependent on 
cerebral tumors, syphilitic gummata, exostoses, etc., electricity can not 
be expected to cure ; but the paretic state of the muscles, left after 
the removal of the gummata, may be promptly relieved by galvaniza- 



384 EXCITO-MOTORS. 

tion. The functional states of the above-mentioned nerves, of which 
paralysis may be a symptom, will certainly be cured by electricity. 
Faradism may sometimes succeed when galvanism fails in these cases 
(Althaus). 

Cases of aphonia, when dependent on paralysis of the vocal cords, 
are sometimes cured by a single application, and few, indeed, resist the 
proper use of galvanism. The larynx may be faradized externally ; 
the recurrent laryngeal may be galvanized by placing one rheophore 
over its trunk and the other over the larynx, or, what is better, an in- 
tra-laryngeal electrode (Mackenzie's) may be used. 

Paralysis of the bladder and of the sphincter ani, even w r hen 
symptomatic of spinal affections, may be greatly benefited, and the 
condition of the patient rendered much more comfortable, by an inter- 
rupted galvanic or faradic current applied by suitable insulated elec- 
trodes. Idiopathic cases of these affections may be cured in this way. 
Constipation, due to atony of the muscular layer of the large intestine, 
can be overcome by the same means. An insulated electrode is intro- 
duced into the rectum, and a large sponge-covered rheophore, well 
moistened, is passed over the abdomen so as to bring every part of the 
large intestine within the circuit. 

The failure of respiration in opium narcosis can be most success- 
fully obviated by faradization of the muscles of respiration. A strong 
faradic current is one of the most effective means of causing uterine 
contractions in cases of post-partum haemorrhage. 

In certain of the " myopathies of spinal origin" but not in all of 
them, electricity gives excellent results. The most decidedly curative 
results are obtained in infantile paralysis. The electrical treatment 
should be begun early, but after the subsidence of all inflammatory 
symptoms. Good results may be looked for if the electro-contractility 
of the muscles is not lost, and if important changes have not occurred 
in the joints. In many cases the affected muscles, although not atro- 
phied, do not respond to the faradic current, but will to the interrupted 
galvanic. The latter should therefore be used until the muscles are 
put into a condition to respond to the former. Besides galvanization 
and faradization of the paralyzed muscles, the electrical treatment 
should include galvanic spinal-nerve and plexus-nerve currents. Thus 
far but little benefit has accrued from the electrical treatment of pro- 
gressive muscular atrophy. If the initial change in this malady were 
myopathic (as asserted by Friedreich), good results from localized 
faradization might be obtained. The author's most recent experience 
as to the curability of this disease by electricity is not in accord with 
Onimus and Legros's, who declare that it is without avail in this dis- 
order, for it does appear to have the power, in some instances, of 
arresting its progress. Posterior spinal sclerosis is sometimes retarded 
in its course and progress by electricity, and galvanization of the spine 



ELECTRICITY. 385 

lessens somewhat the severity of the neuralgic pains which belong to 
this malady. Recently it has been shown that persistent use of the 
faradic brush to the spine, body, and extremities, is in suitable cases 
remarkably effective. Of all the remedial means now employed, this 
is the most promising, for Strumpf, of Dusseldorf, who has revived 
this treatment, reports not only amelioration but apparent cures of 
this before intractable disease. 

Nothing is more certain in therapeutics than the relief to pain by 
galvanization of the affected nerve or nerves. In tic-douloureux de- 
cided relief to the pain is obtained by electrical applications to the 
fifth, and a permanent cure not unfrequently results in those cases 
belonging to the category of the essential neuralgias, so called. The 
best method of application is that advised by Onimus and Legros, 
which consists in placing the positive pole on the point of emergence 
of the affected nerve, and the negative over the superior ganglion of 
the cervical sympathetic. About ten elements of Siemens and Hal- 
ske is the proper strength, and five to eight minutes the proper time, 
for these applications. This method of treatment is, according to 
Frommhold, the most effective remedy for migraine or hemicrania. 

In cervico-brachial neuralgia, and in sciatica, excellent results are 
obtained by galvanization of the affected nerves. The positive pole 
should be placed over the point of emergence of the nerves from the 
cord, and the negative over the main divisions of the peripheral expan- 
sion. Both labile and stabile currents may be employed. A current 
from thirty elements will usually be required. The electrodes should 
be large sponges well moistened. In old cases of neuralgia, a needle 
such as is used for acupuncture, but insulated to near its point, may be 
introduced down to the neighborhood of the nerve-trunk and attached 
to the positive pole, while the negative sponge-electrode may be passed 
over the course of the nerve. This mode of galvanization is especially 
to be recommended in old cases of sciatica. A daily seance of from 
five to fifteen minutes is required usually in cases of neuralgia. The 
cure is much more difficult, and the applications must be continued 
over a much longer period of time, in those cases of neuralgia depend- 
ent on neuritis. Decided amelioration and even cure may be hoped 
for by sufficiently prolonged applications, when the nerves are so far 
altered that induced currents do not cause any muscular contractions. 
Some of the most satisfactory results have been obtained from galvan- 
ization of the uterus in uterine and ovarian nerve-pain. 

In certain kinds of muscular spasm the galvanic current has un- 
questioned utility. Cases of spasmodic wry-neclc (torticollis) of recent 
origin, due to " rheumatism," are quickly relieved by galvanization by 
stabile currents of the affected muscles, and faradization of the opposed 
muscles. Old cases of wry-neck and convulsive tic of the face, and 
writer's cramp, are not benefited by this treatment. Cases of chorea 

25 



386 EXCITO-MOTORS. 

have been cured by static electricity, but little benefit has been derived, 
according to the author's observation, from galvanism or faradism. 

Galvanism is sometimes of great service in epilepsy ', but no exact 
indications for its use can be laid down. Obviously it can only be ser- 
viceable in idiopathic epilepsy. The applications should include the 
brain (transverse current from mastoid process), the cervical sympa- 
thetic, and those nerve-trunks along which an aura is transmitted. 

The author has witnessed some remarkable results from the galvan- 
ization of the pneumogastric nerves, and as conspicuous failures from 
the same practice, in spasmodic asthma. Even in those cases not per- 
manently improved, great relief to the difficult breathing is experienced 
when the current is passing. The positive pole is placed over the pneu- 
mogastric, beneath the mastoid process, and the negative pole is applied 
to the epigastrium. Faradism is not serviceable in this disease. 

^Exophthalmic goitre, a disease of the sympathetic system and 
manifested objectively by proptosis, goitre, and palpitation of the heart, 
is cured by galvanization of the cervical sympathetic and of the pneu- 
mogastric, and by applications to the eyes and thyroid gland, when it 
is merely functional in character. 

There can be no reasonable doubt of the influence of electricity 
over the nutritive functions. Beard and Rockwell employ the method 
termed by them " general electrization," which consists in faradic ap- 
plications to the surface of the body, "one pole, usually the negative, 
being placed at the feet or the coccyx, while the other is applied all 
over the surface of the body." They formulate their principles in 
these applications as follows : " Constitutional diseases are better 
treated by general, and local diseases by localized electrization." Ac- 
cording to Benedikt — and in this view electricians are generally in 
accord — the true method of using electricity consists in making appli- 
cations to the affected part or organs, and, to this rule may be added, 
to those parts or organs also in which symptoms are felt. 

General electrization is useful " in those diseases that are dependent 
on, or associated with, impairment of nutrition and general debility of 
the vital functions, such as nervous dyspepsia, neurasthenia, anwmia, 
chlorosis, hysteria, hypochondriasis, paralysis, and neuralgia of a con- 
stitutional origin, rheumatism and other toxic diseases, some forms of 
chorea, and oftentimes in functional disorders of the genital, digestive, 
and other special organs." 

In anrnmia and chlorosis the usual remedies for these states may be 
much assisted by central galvanization, and localized applications to 
the vegetative organs. Regurgitation of food, gastralgia, and feeble- 
ness of digestion, are often signally benefited by galvanization of the 
pneumogastrics, and by localized applications to the abdominal organs. 
Strong currents are needed when internal organs are to be affected by 
electrodes applied to the integument of the abdomen. A more effec- 



ELECTRICITY. 387 

tive application in these cases consists in the use of an insulated rectal 
electrode, while a sponge electrode of large size, and well moistened, 
is passed over the various organs of the abdomen. The relief of con- 
stipation by this means has already been alluded to. 

Various diseases of the pelvic organs, both in the male and female, 
are successfully treated by electricity. Amenorrhea, when dependent 
on atony of the ovaries and uterus, is cured by static electricity, by 
faradism, or by an interrupted galvanic current. A shock from a 
Ley den- jar may be transmitted through the pelvis, or a strong faradic 
or galvanic current may be applied by means of one pole on the spine, 
the other on the hypogastric region. In the case of married women 
an insulated vaginal electrode may be introduced and placed in con- 
tact with the os uteri. This is a more effective way of making the 
applications than by the electrodes placed externally. In neuralgic 
dysmenorrhoea the galvanic current will afford relief in a large propor- 
tion of cases ; and, in congestive dysmenorrhoea, an inverse current 
will diminish the blood-supply, and thus lessen suffering. The treat- 
ment of these affections should be conducted during the interval. The 
chronic congestive enlargement of the uterus is sometimes remarkably 
benefited by a galvanic current of moderate intensity slowly inter- 
rupted, but it is doubtful if any case of chronic interstitial metritis is 
ever cured, or even ameliorated, by this means. 

Although the changes in the joints, induced by gout and rheu- 
matism, may not be cured by galvanization of the central nervous 
system, as claimed by Meyer, yet there is no doubt that myalgia, lum- 
bago, and other so-called rheumatic diseases of the muscular system, 
may be promptly relieved and cured by the constant current. The stiff- 
ness of the joints and the muscular soreness which remain after an at- 
tack of acute rheumatism are best relieved by passing a mild galvanic 
current through the affected parts. t 

Herpes, especially herpes zoster, and prurigo, when they are refer- 
able to an alteration of the cutaneous nerves, are curable by electricity. 
The author has seen excellent results in cases of shingles, from gal- 
vanization of the affected intercostal nerves — the positive pole being 
placed over the point of emergence of the nerves, and the negative 
brushed over the terminal filaments in the skin. Beard reports the 
cure of obstinate cases of chronic eczema by central galvanization, and 
his results have been confirmed by others. The author has seen a 
number of cases of acne get well under the influence of galvanization 
of the cervical sympathetic, and local galvanization of the skin of the 
face — the positive pole on the neck, the negative passed over the af- 
fected parts. It need hardly be stated that strong currents are not to 
be used when the poles are applied in these situations. Among the 
other skin-affections treated by galvanism with success are prurigo, 
psoriasis, and even scleroderma ; but, as Dr. Piffard, of New York, 



388 EXCITO-MOTORS. 

has remarked, this method is " by no means uniformly successful." It 
is applicable to the treatment of the neuroses of the skin. 

Electrolysis. — When the electrical current is made to traverse 
insulated needles introduced into the tissues of the body, electrolytic 
effects are produced, decomposition of the tissues ensues, hydrogen 
and the alkalies appear at the negative pole, and acids and chlorine at 
the positive. Remak, in his various publications, much insisted on 
the catalytic action of the constant current. Effusions into and about 
inflamed parts, and into the substance of tumors, may be made to dis- 
appear by the external application of galvanism, through moistened 
sponge-electrodes. It is doubtful, however, whether neoplastic forma- 
tions can be thus made to undergo absorption. The disappearance of 
effusions induces such an appearance of shrinking of tumors and in- 
flammatory products, that actual absorption of the neoplastic material 
may be supposed to have occurred. 

Galvano-puncture is used to remove malignant and other new for- 
mations. The sanguine expectations once entertained that cancer can 
be thus removed, although justified by the results in a few apparently 
successful cases, have not been realized. Beard proposed and has 
executed a new method, entitled " working up the base," which con- 
sists in electrolytic decomposition of the subjacent parts of a can- 
cer. A number of needles, insulated to near their points, are intro- 
duced into the healthy tissues beneath the morbid growth, and a cur- 
rent from twenty to sixty elements is passed through them. Decom- 
position ensues, and there takes place a separation of the morbid 
mass. As the pain of this method is great, etherization should be 
resorted to. 

Aneurisms, so situated as to be beyond the reach of surgical inter- 
ference, have been treated by galvano-puncture, but the success, al- 
though brilliant in a few instances, has not been such as to justify 
very sanguine expectations of its future utility. Erectile tumors are 
curable by electrolysis. Goitre is sometimes made to disappear by 
the same means. The cysts connected with glandular tumors in the 
neck may be permanently occluded by galvano-puncture. The most 
useful applications of this method have been in hydrocele, which may 
be often cured in my experience by introducing two needle-electrodes, 
insulated to near their points, and passing a current from twenty to 
forty elements. Not less effective is the same method in the treat- 
ment of hydatid disease of the liver. One needle connected with the 
negative pole is introduced, and the sponge-electrode is placed at some 
indifferent point on the abdomen. 

Spasmodic and permanent stricture of the urethra are treated by 
electrolysis, an insulated sound with a metallic tip, connected with the 
negative pole, being passed into the stricture, and the positive pole 
placed at some indifferent point. The most successful results have 



ELECTRICITY. 389 

been obtained by Mallez and Tripier, and Dr. Robert Newman, of 
New York ; but it is the author's observation, as also the expe- 
rience of Dr. Keyes, of New York, that this method has little real 
utility. 

Wounds and ulcers of an indolent character, and bed-sores, may be 
made to heal by attaching to them a galvanic couplet (zinc and silver), 
one of the elements remaining in contact with the sore, and the other 
on the skin in the neighborhood. They should be connected by a 
copper wire, and be confined to the parts by strips of adhesive plas- 
ter. This method has been especially serviceable in the treatment of 
bed-sores. 

Galvaxo-Cautery. — This method consists in cauterization by a 
platinum wire heated by the galvanic current. The battery used for 
this purpose furnishes a large quantity of electricity of low tension ; 
hence the elements are few in number but have extensive surface. 
When a quantity of electricity is made to traverse a platinum wire 
which offers great resistance, the wire is heated and may be melted. 
The platinum in the form of w T ire-loop, or dome cautery, or knife, 
heated by the electrical current, is the cauterizing agent. If the wire 
be not so highly heated as to cut through the tissues too rapidly, but 
little bleeding results, and a clean surface is left which promptly gran- 
ulates and heals. 

The instruments now employed for galvano-caustic work are chiefly 
the batteries of Piffard and Byrne, and the storage system of Trouve. 
Byrne's is said to be the most efficient of the original caustic batteries. 
The elements of this consist of zinc and platinum, and are so arranged 
as to offer the least resistance. The exciting fluid is bichromate solu- 
tion, and this is kept active by a bellows, or some other arrangement 
for agitating the fluid. 

The storage system is supplanting all other arrangements for the 
purposes of galvano-cautery. This consists of an element or combina- 
tion of elements which may be charged by another battery. The 
form of " storage-cell " or " accumulator " now chiefly used consists of 
plates of lead, immersed in dilute sulphuric acid. These are charged 
by some Daniell or Bunsen cells, communicating with them, and in 
action for several hours. Bubbles of hydrogen gas form on one lead 
plate, and of oxygen on the other ; whence they are said to be "polar- 
ized," and the current produced by the recombination of the gases is 
called a "current of polarization." By such an arrangement the quan- 
tity of electricity furnished by some Bunsen or other cells, acting for 
many hours or days, can be given out in a short time and in immense 
quantity. The accumulators of Faure, charged in Paris, have been 
transported across the ocean to give out their force in New York. 
Trouve has utilized this principle in constructing his " polyscope." A 
storage-cell of Plante is charged by the action of two Bunsen elements, 



390 EXCITO-MOTORS. 

and subsequently the stored-up electricity can be employed in heating 
a platinum wire or knife for cautery purposes, or for illumination. 

When this system is fully developed, storage-cells, or accumulators, 
will be provided from some station and transported to any point de- 
sired, and the force given out as required. Furnished with suitable 
platinum loops, knives, and cautery, the operator can employ the ma- 
chines anywhere. Obviously, this method will be utilized on a large 
scale for various operative procedures — for the removal of the tongue, 
of polypi, of hemorrhoids, for opening the trachea, deep-seated ab- 
scesses, etc. A beautiful application of the galvano-cautery was made 
by Thomas, when he opened the sac of a tubal pregnancy by a gal- 
vanic knife. The evident advantages of this system are the little 
pain which attends the operation, and the absence of haemorrhage. It 
is necessary to accurately adjust the strength of current, so that the 
wire or knife will have the requisite temperature to cut the tissues 
sufficiently and yet not so rapidly as to prevent adequate closure of 
the vessels. (For full details, see the author's " Treatise on Medical 
Electricity," second edition, p. 262, et seq.) 

Static Electricity. — The modified Holtz or Toepler-Holtz elec- 
trical machine is now used to procure all of the nerve and muscular 
effects hitherto obtained by faradic electricity, and also therapeutical 
results of a very striking kind. It has long been known that chorea 
and other nervous affections may be readily cured by static electricity, 
but a remarkable extension has been given to the subject by late dis- 
coveries. Chorea is now treated by the " electric bath," sparks being 
drawn from the spine. If the Holtz machine is used, sparks can readily 
be drawn through the clothing, by presenting the brass knob along 
the spine. The results, which have been so long obtained at Guy's 
Hospital by this mode of electrical applications, are now generally 
conceded. It seems to be the most successful method of treating this 
disease. Neuralgia is now promptly relieved in most instances by in- 
sulating the patient and drawing sparks from along the trajectory of 
the nerve affected. The pains of progressive locomotor ataxia are 
much benefited in the same way, and it is said the disease itself is 
arrested. Amenorrhea, other conditions favorable, is quickly cured 
by sparks, or a shock sent through the pelvis. The general nutrition 
is greatly promoted by electrization by sparks. 

The Toepler-Holtz machine may, by connecting the interior of one 
condenser with the exterior of the other, be utilized to procure the 
muscle and nerve reactions of the faradic current. 

Trouve's Polyscope, referred to above, will probably be largely 
employed in the future, for the purposes of illumination. Suitable 
throat and other mirrors, platinum knives, and loops, are furnished 
with the instrument for illumination of the cavities, and for the va- 
rious caustic operations. It is very powerful, occupies but little space, 



NUX VOMICA. 391 

and promises, when certain mechanical defects are overcome, to fulfill 
more perfectly than any other apparatus the requirements of a surgi- 
cal galvano-caustic and a medical illuminating apparatus. 

Authorities referred to in this article : 

Allbutt, Dr. T. Clifford. The Electric Treatment of the Insane. The. West Riding 
Lunatic Asylum Reports, vol. ii, p. 203. 

Althaus, Dr. Julius. A Treatise on Medical Electricity, second edition, Philadel- 
phia, 1870. 

Bartholow, Dr. Roberts. Medical Electricity. A Practical Treatise on the Applica- 
tions of Electricity, etc., Philadelphia, H. C. Lea's Son & Company, second edition, 1882. 

Beard and Rockwell. A Practical Treatise on the Medical and Surgical Uses of 
Electricity, New York, 1871. 

Benedikt, Dr. Moritz. Elektr other apie, Wien, 1868. 

Duchenne, Dr. G. B. (of Boulogne). Be V Electrisation Localisee, Paris, 1861. 

Erb, Dr. Wilhelm. Handbuch der Elektr other apie, Leipzig, 1882. 
• Eulenburg, Dr. Albert. Lehrbuch der functionellen NervenJcrankheiten, Berlin, 1871, 
p. 78, et seq. 

Frommhold, Dr. Carl. Die Migraine und ihr Hcilung durch Electricitat, Pesth, 1868. 

Gordon, J. E. H. A Physical Treatise on Electricity and Magnetism. In two volumes, 
New York, 1880. D. Appleton & Co. 

Hammond, Dr. William A. A Treatise on Diseases of the Nervous System, New York, 
1871. 

Hamilton, Dr. Allan McLane. Clinical Electro- Therapeutics, New York, 1873. 

Jaccoud, Dr. S. Trait'e de Pathologie Interne, vol. i, Paris, 1870. 

Morgan, Dr. Charles E. Electro-Physiology and Therapeutics, New York, 1868. 

Onimus, E., et Ch. Legros. Trait'e d ' Electricite Medicate, Paris, 1872. 

Remak, Dr. Robert. Galv another apie, traduit de l'Allemand, Paris, 1860. 

Reynolds, Dr. J. Russell. Lectures on the Clinical Uses of Electricity, Philadelphia, 
1872. 

Strumpf, Dr. Centralblatt fur die Neurologische Med., Band i, No 1. 

Voltolini, Dr. Rcdolph. Die Anwendung der Galvano-Kaustic, Wien, 1872. 

Ziemssen, Dr. Hugo von. Die Electricitat in der Medicin, erste Halfte, Berlin, 1872. 

Nux- Vomica. — The seeds of StrycJmos nux-vomica Linne (Nat. Ord. 
Loganiacece). (IT. S. P.) JVbix vomique, Fr. ; Krahenaugen, Ger. 

Abstractum JVucis Vomica. — Abstract of nux-vomica. Dose, gr. 
ss— gr. ij. 

Extractum JVucis Vomicae. — Extract of nux-vomica. Dose, \ — 
gr. h 

Extractum JVucis Vomicce Eluidum. — Fluid extract of nux-vomica. 
Dose, tti j — tti v. 

Tinctura JVucis Vomiccs. — Tincture of nux-vomica. Dose, tti, j — 

in, xv. 

Composition. — Nux-vomica contains two alkaloids and a peculiar 
acid. The alkaloids are strychnine and brucine, and the acid strychnic 
or igasuric acid. The proportion of strychnine ranges from one fourth 
to one half of one per cent, and of brucine from one eighth to one per 
cent. These wide differences are in great part due to the varying skill 
of the chemists who have made analyses. Besides these, another crys- 



392 EXCITO-MOTORS. 

tallizable base has been discovered in the mother-liquor from which 
strychnine and brucine have been precipitated. This has been named 
igasurine. The alkaloids exist in nux-vomica in combination with 
igasuric acid. 

Strychnine is a white or grayish- white powder, of an intensely 
bitter taste, nearly insoluble in water, slightly soluble in cold alcohol, 
and readily soluble in boiling alcohol. When heated it melts, and by 
strong heat is wholly dissipated. It is but slightly or not at all red- 
dened by nitric acid. A small portion dissolved in official sulphuric 
acid yields, on the addition of a minute quantity of bichromate of 
potassium, a splendid violet color. 

Strychnince Sulphas. — Sulphate of strychnine. A white salt, in 
colorless, prismatic crystals, which are without odor, exceedingly bit- 
ter, soluble in ten parts of water, sparingly soluble in alcohol, and in- 
soluble in ether. They effloresce on exposure to the air, and melt 
when heated, losing nearly fourteen per cent of their weight of water 
of crystallization. By a strong heat they are wholly volatilized. Dose, 
gr. A-gr- if (U.S. P.) 

Antagonists and Incompatibles. — The paralyzers, such as woo- 
rara, conium, tobacco, opium, belladonna, and physostigma, antagonize 
the actions of strychnine in a part of the sphere of its influence. 
They do not antagonize its toxic action. Chloral, tobacco, bromide of 
potassium, ether, and chloroform (inhaled), are its true physiological 
antagonists. 

In cases of poisoning, tannin and the vegetables containing it 
should be freely administered, for the tannate of strychnine is very 
insoluble. Emetics, or the stomach-pump, must be used promptly. 
The tetanic spasms are best controlled by chloral and the inhalation 
of ether, or by tobacco, or by the bromide of potassium in very large 
doses ( 3 ij — | ss). The maintenance of artificial respiration has a 
decided effect in postponing in animals as in man the lethal action of 
strychnine. 

Strychnine should not be combined with bromides, chlorides, and 
iodides, in the same solution. Accidents have happened by taking the 
last portion, which will contain all of the strychnine, precipitated as 
hydrobromate, hydriodate, etc. 

Synergists. — Brucine, picrotoxine, thebaine, ergot, and, according 
to my own experimental investigations, belladonna, electricity, cold, 
etc., promote the activity of nux-vomica and its alkaloids. 

Physiological Effects. — The preparations of nux-vomica are ex- 
tremely and persistently bitter. Like all bitters, they promote the 
flow of the stomach and intestinal juices, increase the digestive power, 
and thus favorably affect the appetite. They also hasten the intestinal 
movements, and the stools voided are somewhat relaxed. 

The alkaloids of nux-vomica are very diffusible substances, and 



NUX VOMICA. 393 

enter the blood very quickly. They lessen somewhat the oxidizing 
power of the blood, but this effect is quite insufficient to account for 
the physiological reactions produced in the nervous system. Small 
medicinal doses of nux-vomica and its alkaloid accomplish no more 
than other bitters, as respects the circulation. More or less plethora, 
slightly increased action of the heart, and, as a consequence of this 
condition of the vascular system, a greater energy in the performance 
of the various functions, result from their administration. 

When a lethal dose of nux-vomica, or of its alkaloid, has been 
taken, characteristic symptoms follow in a few minutes. The state 
of the stomach as to food, the presence of tannic acid in the food, and 
of fat, probably ; also the condition of the blood-vessels, influence the 
rate of absorption, and symptoms may begin in a few minutes or be 
delayed an hour or even longer. When a full medicinal dose has 
been taken, some slight shuddering, a sense of constriction of the 
fauces and jaws, sudden pains like electric shocks passing through the 
limbs, startings of some of the voluntary muscles, dilated pupils, " a 
meaningless smile," paleness of the face, followed by flushing and 
increased warmth of the surface and perspiration, are symptoms which 
may be produced without further development of a toxic action. If 
the dose be large enough to cause death, the above-described symptoms 
are quickly followed by tetanic convulsions, in which nearly all the 
voluntary muscles are engaged. When the paroxysm occurs, a shud- 
der passes through the whole frame ; the head and extremities jerk 
and twitch, and then suddenly a general tonic convulsion takes place 
— the limbs are extended, the hands clinched, the toes and feet incur- 
vated, the head bent backward, the body arched and rigid, the 
abdominal muscles hard and tense, the respiratory muscles fixed so 
that the body, curved in the form of a bow, rests on the occiput and 
heels. The countenance assumes a ghastly grin — the risus sardonicus ; 
the arrest of the respiratory movements suspends oxidation of the 
blood, and the skin becomes cyanosed ; strong erections of the penis 
occur, and frequently involuntary evacuations of semen, urine, and 
faeces take place. Rarely does death ensue in the first paroxysm ; 
the spasm relaxes, and nothing remains of the attack but the muscular 
soreness and fatigue, and the sense of impending dissolution. Ab- 
solute quiet retards the paroxysms. At first the senses are preternat- 
urally acute, and, as the reflex function is abnormally excitable, the 
slightest peripheral irritation suffices to bring on the spasms. Gener- 
ally patients experience comfort when the limbs are strongly held, or 
even rubbed, during the paroxysms ; but, in the interval, absolute 
quiet is most grateful. The mind remains unaffected until the close, 
or, at least, until carbonic-acid poisoning sets in. The paroxysms 
rapidly succeed each other, and increase in duration and severity, 
death occurring usually by fixation of the muscles of respiration, or 



394 EXCITO-MOTORS. 

by exhaustion, and within two hours, as a rule, from the beginning of 
symptoms. 

The remarkable similarity in the symptomatology of traumatic 
tetanus and strychnine tetanus requires that the points of difference 
between them be clearly set forth. In strychnine tetanus the jaw- 
muscles are not first thrown into spasm, and are not always rigid dur- 
ing the paroxysm ; in traumatic tetanus, trismus is one of the first 
symptoms. In strychnine tetanus, after the convulsion, lasting from a 
half to one or two minutes, there is usually complete relaxation ; in 
traumatic tetanus rigidity of the affected muscles continues. A case 
of strychnine tetanus goes on rapidly increasing in severity, and lasts 
from a few minutes to two hours ; a case of traumatic tetanus proceeds 
more slowly, and lasts always a number of hours, and may extend over 
days and even weeks. And, lastly, in traumatic tetanus, the capital 
symptom of a wound or injury exists. 

No very characteristic post-mortem appearances result from strych- 
nine-poisoning. The muscles, at first relaxed, become rigid, the feet 
turned in, the fingers clinched, or the body may maintain the position 
of opisthotonos, in which it was at the moment of death. Conges- 
tion of the cerebral and spinal meninges is usually observed, and 
Schroeder Van der Kolk first ascertained that dilatation of the vessels 
and sanguineous extravasations are found in the gray matter of the 
cord (medulla oblongata), and this observation has since been repeat- 
edly confirmed. 

The smallest quantity of strychnine which has produced a fatal re- 
sult in an adult was a half -grain. Rarely can one twelfth of a grain 
be given without causing muscular twitchings, and one sixteenth of 
a grain has caused death in a child of between two and three years. 

The effects of strychnine are exerted on the spinal cord, on the 
seat of the motor functions. It does not affect the functions of the 
motor nerves directly — the irritability of the motor nerves is not de- 
stroyed by strychnine, it is exhausted by over-stimulation. The sen- 
sory nerves are either unaffected, or their irritability is exhausted. 
The reflex functions of the spinal cord are exalted. The afferent 
nerves, while preserving their irritability, communicate impressions to 
the reflex centers, motor impulses are quickly originated, and the mus- 
cles through the motor nerves are fixed in a state of tonic contraction. 
The over-stimulation of the cord and the motor nerves exhausts the 
irritability of the latter. The muscles preserve their contractility. 

The effects of strychnine are not limited to the nervous system of 
animal life : the organic nervous system participates in the perturba- 
tion. The dilatation of the pupil, the erection of the hair-follicles, the 
tinnitus, the increased heat in the limbs, and the perspiration which 
are produced when strychnine is injected subcutaneously, indicate an 
influence on the sympathetic system similar in kind to that exerted 



NUX VOMICA. 395 

«. 

on the voluntary. Experimental investigations have confirmed these 
clinical observations. A very considerable rise in the arterial pressure, 
contraction of the vessels in the frog's web, and increased action of 
the heart, have been experimentally demonstrated to be caused by 
strychnine (Sigmund Mayer). 

Magendie, who made the first study of the actions of strychnine, 
found that, by previously destroying the spinal cord, no convulsions 
followed the administration of a poisonous dose. The precise agency 
of the cord is disputed, but it is in a high degree probable that the 
condition is one of exaggerated reflex excitability, so that the smallest 
possible peripheric irritation induces a response in the reflex motor 
center. When Setschenow's inhibiting center of reflex movements is 
withdrawn as in the decapitated frog, the spasms are induced as before. 
The passage over the face of the faintest current of air, even the men- 
tal conception of such an impression, will excite the spasms. Abso- 
lute repose, as by placing the poisoned frog under a bell-glass, the 
table firm so that no jar can reach the animal, and light excluded, has 
a decided effect in preventing attacks. If a poisoned human subject 
is similarly protected, the convulsions are diminished in violence. 
Again, if, when the convulsions are impending, the limbs are firmly 
grasped and held, the force of the spasm is lessened thereby. The 
medicines most effective in affording relief are those which lower the 
activity of the reflex function— notably chloral, bromide of potassium, 
etc. These facts indicate that an exaltation of the reflex function of 
the spinal cord is caused by strychnine. But this is probably not 
alone sufficient : irritation of the motor cells is also a factor (Spitzka). 
In opposition to the commonly accepted view, Falck maintains that 
strychnine acts primarily on the brain, or rather on the vaso-motor 
center of the brain, then on the inhibitory center for the heart, and the 
respiratory center, and lastly on the reflex apparatus of the cord. The 
spasms are the combined results of these actions. 

Bernard held that the sensibility of the sensory nerves is destroyed 
by strychnine, but after the motor functions have ceased. Martin- 
Magron, and subsequently Yulpian, ascertained that the sensibility 
persists after motility has ceased. This contradiction of supposed 
facts has been examined more recently by Busch, whose observations, 
if entitled to belief, support the statement of Bernard. Busch has 
found that the toe of the poisoned frog may be crushed, and the cen- 
tral portion of the divided sciatic may be burned, without inducing 
spasms or reflex movements, when the slightest jar of the animal will 
cause strong convulsions. Kolliker and Vulpian, with many others, 
hold that the excitability of the motor nerves is so far impaired by 
strychnine that irritation of the nerve-trunk produces very feeble or 
no muscular contractions. The American observers Klapp and Spitzka 
both maintain that the peripheral nerves are unaffected in strychnine- 



396 EXCITO-MOTORS. 

poisoning. Martin -Magron et Buisson and Vulpian find that the action 
of strychnine is local on the nerves, and is therefore greatly influenced 
by the quantity of the poison reaching them. If the dose of strych- 
nine is small, the motor and sensory nerves remain unimpaired ; but if 
the dose be large, their irritability is destroyed. The influence of the 
quantity administered is consequently very great, and is exhibited in 
other respects. Thus, while a merely lethal dose causes strong con- 
vulsions, a very large toxic dose will kill at once without any reflex 
disturbances. It is impossible, then, to make the distinction between 
motor and sensory nerves as respects the action of strychnine: it either 
destroys or spares the excitability of both. 

While strychnine exalts the irritability of the reflex motor center, 
it stimulates the vaso-motor center or centers in the cord, with the re- 
sult of greatly increasing the blood-pressure. This rise in blood-press- 
ure is prevented by dividing the cord, according' to Mayer, Klapp, 
and others, but, according to Schlesinger, not. Now, as it has been 
found by Richter, who has studied the circulation in transparent parts, 
by Mayer, and by Spitzka, that the arterioles strongly contract under 
the influence of strychnine, the blood-pressure must rise from this 
cause ; hence, the observation of Schlesinger is probably correct, that 
the blood-pressure rises in strychnine-poisoning, notwithstanding di- 
vision of the cord. As has been tersely expressed by Spitzka, " its 
vaso-motor effect is to increase the blood-pressure and the rapidity of 
the blood-current by contracting the arterioles. This effect is inde- 
pendent of the central nervous system." The effects of strychnine on 
the heart differ in cold- and warm-blooded animals, according to most 
authorities, and decidedly, also, according to the size of the dose. On 
frogs, the diastolic pause is prolonged, and the force of the systole 
augmented, so that arrest of the heart's action may take place in te- 
tanic rigidity. These results, Spitzka holds, are due to an action on 
the cardiac ganglia and on the pneumogastric. The previous obser- 
vations of Heinemann, however, do not correspond, for he finds that 
these phenomena are produced after the vagi are divided. In warm- 
blooded animals the heart's action is accelerated, while the tension is 
raised. Klapp, however, finds that strychnine slows the pulse in the 
cat and rabbit, and that the retardation is due to an impression on the 
cardiac motor ganglia, and not to stimulation of the inhibition. He 
finds that the action is the same on both classes of animals. These 
contradictions are probably due to the difference in the dose employed. 
A large toxic dose of strychnine will paralyze, instead of stimulate, 
the vaso-motor center in the medulla, and thus prevent any rise of 
blood-pressure. A small, merely lethal dose will stimulate the cardiac 
ganglia, the pneumogastric, and the vaso-motor ganglia ; but a large 
toxic dose will slow the heart, paralyze the vagi and the accelerator 
apparatus, and depress the vaso-motor functions generally. In the 



NUX VOMICA. 397 

course of annual experiments for class instruction, the author has con- 
stantly observed the difference in results due to the quantity adminis- 
tered. 

From clinical observation, in the absence of any experimental evi- 
dence, strychnine has been ascertained to have a stimulating effect on 
the respiration. If the dose is less than sufficient to tetanize, the func- 
tion of respiration is increased in energy and in depth. Hence, this 
agent antagonizes the respiratory poisons, as well as those morbid 
states which depress the respiratory function. 

On the blood, the experiments of Harley show, strychnine has some 
action. Agitation of blood with the air, in the presence of strychnine, 
is followed by a less production of carbonic acid than if strychnine be 
not present, but such experiments are entitled to small consideration. 
Strychnine, as Hippel and Cohn have shown, stimulates the retina and 
increases the sharpness of definition and the area of the visual field. 
These facts explain the curative effects of strychnine in certain dis- 
eases of the retina. 

Very peculiar phenomena have been observed by Spitzka as a re- 
sult of chronic poisoning — an entirely new subject. It appears to be 
exceedingly difficult to keep animals alive, but Spitzka succeeded in 
maintaining five frogs in tetanus for over forty days. Symptoms oc- 
cur under these circumstances quite distinct from those produced in 
acute poisoning by strychnine. Disease in the cord is set up, " partly 
as an insular sclerosis, partly as an hemorrhagic or non-haemorrhagic 
myelitis." These experiments demonstrate that, to maintain a con- 
stant effect by strychnine in the beginning, the dose must be increased, 
but later the quantity given may be decreased and administered at 
longer intervals. The importance of these observations from the ther- 
apeutical point of view is, indeed, great. The symptoms occurring 
from chronic poisoning are, as respects the spasms, a diminution of 
their energy, the development of an ataxic state, with tremors and 
pupillary myosis. These phenomena approach those produced by pi- 
crotoxin, and are intermediate between the effects of strychnine proper 
and of curara or methyl strychnium. 

Therapy. — The tincture of nux-vomica is one of the numerous 
remedies proposed for the vomiting of pregnancy. It is best adapted, 
according to the author's observation, to those women who have a sea- 
sick feeling and who do not vomit much. Half a drop to a drop, 
in cherry-laurel water, or in simple water, every hour or two, is a 
suitable dose. Like all other remedies, nux-vomica often fails in this 
malady. Owing partly to its intense bitterness, and partly to its in- 
fluence on the nervous system, the tincture of nux-vomica is an excel- 
lent stomachic tonic, adapted more especially to the treatment of those 
cases in which there is a neurotic element, as, for example, atonic dys- 
pepsia and gastralgia. From five to ten drops three times a day be- 



398 EXCITO-MOTORS. 

fore meals is a suitable dose in these cases. In chronic gastric catarrh, 
whether occurring as an independent affection, or as an accompani- 
ment of other maladies, the tincture of nux-vomica is one of the most 
effective bitters. In the gastric catarrh and morning vomiting of 
drunkards, this remedy is next in value to arsenic. It may be given, 
advantageously, with mineral acids. The poor appetite, the feeble 
digestion, and the nervousness and trembling, which follow the sudden 
withdrawal of alcoholic stimulants, may be removed by frequent small 
doses of the tincture. To diminish the craving for stimulants when 
they are withdrawn, and to sustain the nervous system, the following 
combination is exceedingly effective : ^ Tinct. capsici, 3 vj ; tinct. 
nucis vom., 3 ij. M. Sig.: Twenty drops in water every four hours. 
Intestinal indigestion and flatulence are also removed by tincture of 
nux-vomica. 

In atonic diarrhoea, nux-vomica is a serviceable addition to other 
remedies, when a paretic condition of the muscular layer of the bowel 
may be presumed to exist. It is, however, more especially in consti- 
pation that nux-vomica is useful. It is indicated in those cases in 
which there are inaction of the muscular layer and, consequently, great 
fecal accumulations. It may be most advantageously given with pur- 
gatives in such cases : fy Tinct. aloes et niyrrhae, 3 vj ; tinct. nucis 
vomicae, 3 ij. M. Sig.: Fifteen to thirty drops two or three times a 
day. 

Nux-vomica has been signally useful in some forms of epidemic 
dysentery. It is indicated when there is depression of the vital forces, 
the intestines distended with gas, the stools like prune-juice. In some 
epidemics of cholera, strychnine, combined with mineral acids and 
opium, has appeared to be effective when the patient was about to pass 
into the state of collapse ; and it has also been used as a prophylactic 
during the preliminary diarrhoea : IJ Strychninae sulphat., gr. J ; acid, 
sulphuric, dil., § ss ; morphinae sulphat., gr. ij ; aquae camphorae, § iijss. 
M. Sig. : A teaspoon ful every hour or two, well diluted. This combi- 
nation is also effective in summer diarrhoea, when the evacuations are 
very watery, and in colliquative diarrhoea. When there is much pain, 
the quantity of morphine may be increased, or the first dose may be 
doubled. When the character of the case is such as to require con- 
tinued use of the prescription, of course, the quantum of strychnine 
must be lessened. 

Nux-vomica and its alkaloid strychnine are much used in combi- 
nation with restorative remedies, in cases of impoverished blood — in 
ancemia, chlorosis, hmmorrhagic diathesis, purpura, etc. In anaemia 
and chlorosis strychnine is used with reference to its power to stimu- 
late the blood-making organs, which functionate under some special 
influence proceeding from the nervous system. I£ Ferri sulph. exsic, 
3ij ; quininae sulph., 3j ; strychninae sulph., gr. ss. M. Ft. pil. no. 



NUX VOMICA. 399 

xx. Sig. : One pill three times a day. No prescription is more gen- 
erally useful in these states than the sirup or elixir of iron, quinine, and 
strychnine, a formula originally proposed by Aitken. 

In the treatment of amenorrhcea, the preparations of nux-vomica 
and strychnine frequently enter into the composition of prescriptions. In 
post-partum hcemorrhage, Fordyce Barker prescribes the tincture of 
nux-vomica (twenty drops), and fluid extract of ergot (thirty drops), 
" every half-hour until well assured that the uterus is well contracted." 
It is obvious that not more " than two or three doses " of such strength 
will be safe. The neuralgic form of dysmenorrhoea may be permanently 
removed by nux-vomica given during the interval. 

When impotence is due to mere relaxation and atony of the erectile 
apparatus, and is not dependent on organic defects, the preparations of 
nux-vomica are indicated and are useful. Incontinence of urine, when 
due to a paralytic state of the sphincter, may sometimes be cured by 
strychnine. Nocturnal incontinence, which is most successfully treated 
by belladonna, ergot, and iodide of iron, is sometimes not relieved by 
these agents, when strychnine may be tried. The author can not state 
with precision the cases in which it succeeds, but it has appeared to 
him most successful in those cases dependent on simple atony of the 
bladder, associated with general laxity of fiber. 

The most important uses of nux-vomica and its alkaloid are in the 
treatment of nervous affections, chiefly in paralysis. It may be used 
with advantage in hemiplegia, when sufficient time has elapsed to per- 
mit repair of the damage done by the extravasation. It is improper to 
use strychnine during the period of " early rigidity," and it is without 
avail in cases of " late rigidity " of the paralyzed members. It is most 
useful when the paralyzed members are completely relaxed. It is use- 
less when the paralysis has existed so long that the muscles have under- 
gone fatty degeneration, so that they no longer respond to a f aradic or 
slowly-interrupted galvanic current. Even if the necessary conditions 
as respects the state of the muscles are present, strychnine is inadmis- 
sible in cases of paralysis of cerebral origin when there are vertigo, 
headache, and tinnitus. 

In paraplegia of reflex origin, in rheumatismal paraplegia, in syphi- 
loma of the spinal meninges, paraplegia continuing after the removal 
of the deposits, strychnine is a most serviceable remedy. 

The best results are obtained from the use of strychnine in local 
paralysis, in lead-colic and constipation, and in drop-iorist, in mercu- 
rial and paludal palsies, in rheumatismal paralyses — for example, fa- 
cial paralysis, from exposure of the face to cold — torticollis, spinal 
curvature, from paresis of the muscles on one side, etc. 

In certain forms of spasms strychnine sometimes achieves most im- 
portant results. The evidence which has been accumulated as to the 
curative power of strychnine in tetanus would be very conclusive if 



400 EXCITO-MOTORS. 

it were worthy of credence, which seems to the author doubtful. In 
this disease it should be given so as to substitute the strychnic for the 
traumatic tetanus, but the symptoms induced should not exceed those 
due to a full medicinal dose. Strychnine is most successful — as indeed 
are all the appropriate remedies — in the more chronic cases of tetanus, 
and in those of spontaneous rather than traumatic origin. 

Trousseau's experience is strongly in favor of the use of strychnine 
in the treatment of chorea. The method which he has pursued does 
not commend itself — it is heroic, and indeed unsafe. It consists in the 
use of such doses, beginning with one dose a day and increasing them, 
until stiffness of the muscles of the neck, spasmodic jerkings, and a 
" meaningless smile," indicate the beginning of strychnic poisoning. 

Strychnine is a very serviceable remedy in idiopathic or essential 
epilepsy. It is adapted to pale, anaemic young subjects who have the 
petit mal, as well as the grand mat, and whose attacks are nocturnal. 
It exerts no influence but an injurious one over symptomatic epilepsy — 
that dependent on " coarse organic lesions of the brain." It is said 
that the state of the retinal circulation furnishes an indication for 
strychnine or bromide of potassium, fullness of the retinal vessels be- 
ing an indication for the latter agent, and pallor and anaemia for the 
former. 

In that functional irritability of the nervous system manifested by 
restlessness and wandering neuralgic pains , strychnine affords relief. 

Spasmodic asthma of nervous subjects, when the paroxysms are 
due to an irritable state of the nervous system, are associated with 
vague neuralgic pains, and are determined by psychical influences, may 
be so far influenced by the persistent use of strychnine as to occur 
much less frequently. 

Amaurosis of a functional kind, from lead, tobacco, and alcohol, 
may be cured by strychnine. Paralysis of the ocular muscles (proso- 
palgia), of the muscle of accommodation, and paralysis of a single 
muscle, when these affections are due to an arrest of function of the 
nerve or nerves, and do not involve changes of structure, are curable 
by strychnine. Nagel, however, reports a cure of amaurosis in which 
there existed white atrophy of the optic disks ! 

Holtenhof points out the kind of amblyopia most benefited by this 
treatment. The cases without serious lesion, those dependent on anae- 
mia, on a reflex effect from some part of the trigeminus or sympa- 
thetic, or due to the abuse of tobacco and alcohol, are especially 
amenable to the strychnic treatment. " In central amblyopia," says 
Holtenhof, " without lesion of the macula and with decoloration of the 
temporal portion of the optic disk, I have obtained remarkable im- 
provement by the use of strychnine." Again, when there are lesions 
resulting from the deep-seated inflammation of the membranes, im- 
provement may be hoped for when the primary inflammation has 



NUX VOMICA. 401 

ceased and the consecutive atrophy is stationary. In retinitis pigmen- 
tosa the results produced by strichnine are very striking. In five cases 
the diurnal dimness of vision and the nocturnal blindness were relieved 
considerably, in four cases there ensued an augmentation in the acuity 
of vision, and in two the visual field for white light was enlarged. 
Holtenhof finds strychnine inferior to electricity in the treatment of pa- 
ralysis of the ocular muscles. 

Strychnine has remarkable powers as a respiratory stimulant. Since 
the introduction of Aitken's formula for the phosphate of iron, qui- 
nine, and strychnine, the fact of its utility in chronic bronchitis, in- 
cipient phthisis, dilated bronchi, etc., has been distinctly recognized. 
The good effects of this combination are due chiefly to the strychnine. 
ATe possess no remedy more generally effective in the vomiting of 
phthisis than strychnine. This vomiting is reflex mainly, and occurs 
at the termination of a paroxysm of coughing, but there is also more 
or less stomachal indigestion. As the stomach is emptied, the vomiting 
interferes with nutrition. Strychnine has also, as Murrell has shown, 
some power to lessen the sweating of phthisis. This agent may, there- 
fore, be regarded as an important remedy in consumption. There are 
several modes of administration, but the best is by solution, the alka- 
loid dissolved in water with a mineral acid : I£ Strychninae, gr. j ; 
acid, muriatic, dil., § j. M. Sig. : Five to ten drops in water three 
times a day. 

Strychnine is one of the antidotes to chloral, as was first shown by 
Liebreich, but it is not the chief. It may be utilized cautiously as one 
of the means of counteracting the respiratory and cardiac depression, 
but it should not be depended on wholly. 

Nux-vomica has been used with success in the treatment of inter- 
mittents. At present it is rather employed as an adjuvant to quinine, 
than relied on as the sole curative agent. 

Hypodermatic Injection of Strychnine. — This important thera- 
peutical measure needs to be separately discussed. The solution which 
the author advises is as follows : I£ Strychninae sulphat., gr. j ; aquae 
destil. vel aquae lauro-cerasi, 3 j. M. Sig. : Ten minims contain one- 
forty-eighth of a grain. Some heat is usually necessary to procure 
a perfect solution. 

" The effects of strychnine," as has been well remarked (Echeverria), 
" are widely different when administered hypodermically or by the 
mouth. By the latter method the quantity may be repeated and in- 
creased, unsuccessfully, . . . and yet a smaller dose of the substance, 
exhibited hypodermically, be capable of regenerating at once the lost 
muscular power." 

The indications for the subcutaneous use of strychnine are precisely 
as those given above for its stomach administration : it is contraindi- 
cated in cases of hemiplegia when the injury to the brain has been 
26 



402 EXCITO-MOTORS. 

recent. It generally does no good, but harm, when the paralyzed 
muscles are rigid. It is most useful in old cases of hemiplegia, the 
subjects not being advanced in life, the paralysis incomplete, the 
muscles flaccid but not wasted, and having preserved their electro- 
contractility. Yery remarkable improvement not unfrequently fol- 
lows from this mode of treatment in suitable cases. 

The hypodermatic injection of strychnine sometimes is entirely 
successful in curing paraplegia, but the limits of its utility are well 
defined. It is not proper, and is in every way injurious, in acute 
cases involving structural alterations of the spinal cord. In doubtful 
cases, a strychnine injection may be used as a means of diagnosis be- 
tween structural and functional diseases of the cord : in the former, 
the symptoms are increased in definition ; in the latter, they are ame- 
liorated by the injection. This mode of using strychnine is curative 
in reflex paraplegia, in paraplegia due to anmmia of the cord, in hys- 
terical paraplegia, and in those cases of paresis of the muscles of the 
inferior extremities due to concussion of the cord, to rheumatism of 
the meninges, and to syphiloma, after the local morbid process has 
ceased. 

In infantile paralysis, the hypodermatic injection of strychnine is 
an important addition to other means of treatment. If the electro- 
contractility of the affected muscles is not lost, very beneficial results 
may be expected : the injection promotes the capillary circulation, 
and increases the growth and power of the muscles. £ 

In no form of paralysis is the use of strychnine more conspicuous 
for good than in diphtheritic paralysis. Few cases are not promptly 
benefited and most are quickly cured. The utility of the subcutaneous 
injection of strychnine has been most signally exhibited in the local 
paralyses ; e. g., facial paralysis, aphonia from paralysis of the vo- 
cal cords ; paralysis of the extensors by lead ; paralysis of the sphinc- 
ter vesical, of the sphincter ani, etc. 

The mode of practicing the injection is of considerable importance. 
The solution should be thrown into the substance of the paralyzed 
muscles. For example, in hemiplegia, the muscles in turn, of the 
paralyzed side, should be pierced by the needle, and the solution dis- 
charged into them. In drop-wrist the extensors should be grasped, 
made tense, and the needle of the syringe be thrust well into them. In 
paralysis of the sphincter ani and prolapse of the bowel, the muscle 
affected should be penetrated by the needle. When the affected mus- 
cles are beyond reach, the injection may be practiced at any indifferent 
point. 

Next to the treatment of paralyses, the most frequent application 
of strychnine by the hypodermatic method is in certain ocular mala- 
dies. In the normal condition, strychnine affects the visual functions. 
Hippel first studied these effects, afterward Sandi and Cohn, and sub- 



NUX VOMICA. 403 

sequently, in France, Coumetou and Rouire. According to Counietou, 
strychnine augments the excitability of the retinal elements, increas- 
ing the sharpness of vision, central and peripheral, and also enlarging 
the visual field. He advises its use in amblyopia without lesions, de- 
pendent on functional disorder of the retina, and says it may also, if 
the lesions are not too far advanced, effect favorable changes in 
chronic diseases of the optic nerve and retina. Rouire also agrees 
with previous observers in stating that strychnine affects the optic 
nerve-fibers, increasing the normal acuity of vision and enlarging the 
visual field. He advocates its use in tabetic atrophy, and calls atten- 
tion to the fact that in certain atrophies good results are obtained 
only by a progressive increase in the amount administered. In these 
ocular maladies the solution may be injected in the temple, or in the 
nape of the neck, taking the usual precautions against accident. 

In infra- orbital neuralgia, good results have been obtained from 
the subcutaneous injection of strychnine. This practice may be very 
useful in neuralgia characterized by anaemia and depression. It may 
also be highly serviceable in epilepsy, the cases selected according to 
the rules already defined. 

Authorities referred to : 

Bernard, Cl. Lecons sur les Effets des Substances Toxiques et Medicamenteuses, Paris, 
1857. 

Brunton, Dr. T. L. St. Bartholomew'' s Hospital Reports, vols, xii and xv. 

Busch, Dr. Berliner klin. Wochenschrift, No. 37, 1874. 

Coumetou, Dr. TJiese de Paris. Strychnia dans la Chirurgie Oculaire. 

Delioux de Savignac, Dr. Bull. General de Therap., 1871, January, February, and 
March. 

Echeyerria, Dr. M. Gonz. Treatment of Paralysis by the Hypodermic Injection of 
Strychnine. Connecticut Med. Society ; Trans, for 1868. 

Eclenburg, Dr. Albert. Lehrbuch der functionellen Nervenkrankheiten, Berlin, 1871, 
p. 450. Also, Hypodermatische Injectionen. 

Falck, F. A. Archiv fur experimented Pathologie und Pharmacologic, Band iii, p. 77. 

Freusberg, A. Ibid., Band iii, p. 204 u. 308. TJeber die Wirkung des Strychnins 
und Bermerkungen uber die reflectorische Erregung der Nervencentren. 

Gorochofzeff, N. Deutsche Klinik, xl, 1874, p. 316. Versuche mit Strychnin. 

Holtenhof, Dr. Lyon Medicate. Quoted by Annuaire de Therapeutique, 1877, p. 
55, et seq. 

Haughton, Dr. Samuel. Tlie British Medical Journal, June 22, 1872, p. 660. Poi- 
soning by Strychnine treated by Nicotine. 

Heinemann, Dr. Carl. Vir chow's Archiv, vol. xxxiii, p. 394. 

Hunter, Mr. Charles. Pamphlet containing reprints of various papers on Hypoder- 
mic Injections. 

Jochelsohn, Dr. On the Influence of Artificial Respiration over Poisoning by Strych- 
nine. London Medical Record, vol. i, p. 82. 

Klapp, Dr. W. H. The Journal of Nervous and Mental Diseases, vol. v, 1878, p. 619. 

Lecbe, Dr. William. Archiv fur Anat. und Physiologie, 1867, p. 629. 

Kolliker, Prof. Dr. Virchoio's Archiv, Band x, p. 239. 

Mayer, Dr. S. Archiv fur experimenielle Pathologie und Pharmacologic, Band ii, p. 458. 

Xagel, Prof. Dr. Berliner klinische Wochenschrift, vol. viii, p. 6, 1861. 



404 EXCITO-MOTOKS. 

Schlesinger, Dr. London Medical Record, vol. ii, p. 35. 

Spitzka, Dr. £. C. Journal of Nervous and Mental Diseases, vol. vi, 1879. 

Vulpian, Dr. Archives de Physiologie, Normale et Pathologique, 18*70, p. 116, et seq. 

Ignatia. — Ignatia. The seed of Strychnos Ignatii Bergius (Nat. 
Ord. Loganiaceoe). (IT. S. P.) St. Ignatius's bean ; F&ve de Saint- 
Ignace, Fr. ; Ignazbohnen, Ger. 

Abstraction Ignatioe. — Abstract of ignatia. Dose, gr. J — gr. j. 

Tinctura Ignatice. — Tincture of ignatia (10 parts of ignatia to 100 
parts of menstruum). Dose, tti, ij — nj, x. 

Composition. — Ignatia has the same composition as nux-vomica, 
but yields relatively larger proportions of the alkaloids strychnine and 
brucine. These principles exist in the bean in combination with iga- 
suric acid. Formerly, the bean of St. Ignatius was the principal 
source of commercial strychnine, but the abundance and low price of 
nux-vomica now compensate for the difference in strength. The 
preparations of ignatia are stronger than the corresponding ones of 
nux-vomica. 

Antagonists, Incompatibles, and Synergists are the same as for 
nux-vomica. 

Actions and Uses. — Ignatia, containing the same principles as 
nux-vomica, must have the same physiological actions and correspond- 
ing therapeutical properties. 

The tincture of ignatia, the most useful preparation, has a power- 
ful and persistent bitter taste, and, in common with bitters, has the 
effect known as stomachic tonic. It is a very effective stimulant of 
the gastric mucous membrane, promotes the flow of gastric juice, and 
hence increases the activity of the stomach digestion, and may there- 
fore be used with advantage in atonic dyspepsia, and in the nausea 
and vomiting of gastric and cerebral ansemia. It is also often highly 
serviceable in the gastralgia of nervous women having impoverished 
blood. The migraine or sick-headache of such subjects, also, may be 
relieved by ignatia. It may be very useful in the various disturbances 
belonging to chronic gastric catarrh, but it is contraindicated in all 
acute inflammatory affections. It is in these stomachal affections 
more especially that ignatia is preferred to nux-vomica by many prac- 
titioners. 

Ignatia affects the nervous system of animal life in the same way, 
but more energetically in the same dose, that nux-vomica does. It 
exalts in the same way the reflex function of the spinal cord, and simi- 
larly arrests respiration by a tetanic fixation of the respiratory mus- 
cles. It is, however, not used in affections of the nervous system, the 
alkaloid strychnine being now universally employed. 

Cocculus. — The fruit of Anamirta cocculus, or Cocculus Indicus. 
(Not official.) 



COCCULUS. 405 

There are no official preparations except picrotoxin, the active prin- 
ciple. A saturated tincture may be used. Dose, % ij — tti xv. A 
fluid extract can be made, and is a useful form for administration. 
Dose, tti ij to Tii x, gradually increased. 

Composition. — The effects of cocculus are due chiefly to the presence 
in it of a peculiar neutral principle known as picrotoxin. This has been 
admitted to the Pharmacopoeia of 1880, and is therefore official. 

Picrotoxinum. — Picrotoxin. Is not an alkaloid, although allied to 
this group of substances. It does not combine with acids to form salts. 
It is neutral, crystallizable, forming needle-shaped, stellar, or foliaceous 
crystals. It is soluble in 150 parts of cold and 25 parts of warm water, 
and in alcohol, and dissolves freely in alkaline solutions. It is unaffected 
in solution by the metallic salts, tannin, etc., and is not precipitated by 
the tests for the alkaloids. It may be administered in pill-form, and 
can be combined with any of the usual so-called nervine tonics. Pi- 
crotoxin may be administered subcutaneously, in solution in water — 
one grain to f ss — the dose ranging from ■£$ of a grain to -fe of a 
grain. By the stomach it may be given in from -^ of a grain to -fa. 

Antagonists. — The carefully - conducted researches of Browne 
show that chloral is its physiological antagonist in rabbits and Guinea- 
pigs, and probably will prove to be of value in cases of poisoning in 
man. The anaesthetics, and the motor depressants in general, are an- 
tagonistic in respect to its power to produce spasm. 

Synergists. — All the remedies of this group, notably strychnine, 
brucine, and ergot, increase the effects of picrotoxin. 

Physiological Actions. — The taste of picrotoxin is bitter. It 
increases the flow of saliva. In what form soever administered, more 
or less nausea is produced, when the quantity given is sufficient to 
cause cerebral effects. It is not an irritant to the gastro-intestinal 
mucous membrane ; it increases secretion, and promotes peristalsis, 
but no hyperemia of the mucous membrane has been observed after 
death from a toxic dose. The secretions of the glandular appendages 
of the mucous membrane, probably also of the pancreas and liver, are 
decidedly increased, the stools becoming soft and more copious. Ad- 
ministered at any point, picrotoxin diffuses readily into the blood, 
but nothing is known at present of the changes which it induces, if 
any, in the composition of the blood. After death the right side of 
the heart is distended, and the left side incompletely emptied and 
flaccid. The action of the heart varies with the stage of the effects, 
and doubtless also more or less according to the size of the dose. At 
first the cardiac movements are slowed, the arterial tension somewhat 
elevated ; during the convulsions the action grows rapid, but, succeeding 
the convulsions, and during the stage of coma, the pulse becomes slow 
again. According to Planat, by small doses, the cardiac pulsations are 
slowed before the convulsions come on : then the muscular excitement 



406 EXCITO-MOTORS. 

induces rapid action, to be succeeded again by the retarding effects of 
the remedy, increased by the coma. Roeber also finds that the cardiac 
contractions are retarded, and the walls of the heart dilated and flac- 
cid. The respiration is also accelerated, and there occurs strong in- 
spiratory dilatation, because of spasm of the glottis — effects which are 
due to stimulation of the pulmonary portion of the vagus, and which 
cease on division of this nerve (Roeber). When the convulsions cease, 
the respiration becomes slower and more shallow. No engorgement of 
the lungs is found after death (Browne). 

The pupils are not specifically affected. During the convulsions 
they dilate somewhat, when the tonic spasms come on, and contract 
again during the clonic spasms. The fundus of the eye, examined by 
the ophthalmoscope, exhibits considerable hyperemia. 

The cerebral effects of picrotoxin are variously interpreted. Drow- 
siness, stupor, some muscular trembling, are observed in cold- and 
warm-blooded animals, and have also been experienced in man. A 
heavy, stupid intoxication, with vertigo, inco-ordination, and dimin- 
ished sensibility, followed by after-headache, depression, and nausea, 
are symptoms ascribed to the action of cocculus Indicus in beer so- 
phisticated by this drug. Restlessness, unsteady gait, and weakness of 
the hind extremities, also precede the convulsions in animals. Twitch- 
ing of the ears, shaking of the head, and spasms in the eyelids, eye- 
brows, lips, and fore-paws, now come on. Then follows a distinct 
tonic convulsive stage, with opisthotonos, or emprosthotonos, tetanic 
fixation of the muscles of respiration, cyanosis, and stertor. This 
tetanic stage is succeeded by the general clonic convulsions, and the 
seizure is terminated by a temporary paralysis and coma. In the order 
and succession and character of phenomena, a remarkable similarity in 
the actions of picrotoxin to the epileptic paroxysm must be discerned. 
By Roeber the convulsions are referred to the effects of the poison on 
the medulla. He finds that, after destruction of the brain, the symp- 
toms are the same as before ; after destruction of the optic lobes, the 
convulsions are less violent ; but when the medulla is removed the con- 
vulsions do not occur, and a large dose causes coma only. These facts 
indicate that picrotoxin acts on the spasm and vagus centers in the 
medulla, and on Setschenow's inhibitory center. Planat, Chirone, 
and Testa, also hold that this agent acts on the cerebellum, medulla, 
and spinal cord, and leaves the brain exempt. Against these opinions 
we have the carefully-considered but still hypothetical view of Browne, 
who finds in Ferrier's cortical centers the real seat of the action of 
picrotoxin. That the center, and not the periphery, is the place 
where the action of the poison is expended, seems proved by the 
studies of Roeber, who finds that the electrical reactions of nerve and 
muscle remain unaltered. 

The action of the heart is arrested in the diastole, and, while the 



COCCULUS. 407 

cavities are full, the capillaries at the periphery are empty. The vas- 
cular lesions, post mortem, are similar to those of epilepsy. That some 
of the poison is yet in the blood, is proved by the fact that flies eating 
it are poisoned. Elimination probably takes place by the various chan- 
nels of excretion, but chiefly by the kidneys. The skin is powerfully 
acted on, and hence picrotoxin ranks among the most active diapho- 
retics. The urinary excretion is also increased, but more exact obser- 
vations are needed on these points. 

Therapy. — Picrotoxin will, probably, be found very useful in 
cases of torpor of the intestines, dependent on deficient secretion and 
paresis of the muscular layer. In the night-sweats of consumption it 
has been used with great success by Murrell, who had but one failure 
in twenty cases. He finds that it is best to give the necessary dose at 
night — from y-^ grain to g^. The effect lasts about ten days, when 
the sweating begins again, and the remedy must be repeated. Picro- 
toxin has been used with success in the treatment of epilepsy by Pla- 
nat, Dujardin-Beaumetz, Hurd, and by Hammond. It is more espe- 
cially adapted to the weak and anaemic type. It has been also used 
with success in chorea, and with promising results in paralysis agitans. 
In a case of glosso-labio-laryngeal paralysis Gubler obtained a notable 
amelioration. Further experiences with these diseases are much need- 
ed. It is probable that this remedy may be applied with advantage 
to the treatment of other paralyses. According to Tschudi, it has 
been given in paralysis of the sphincters with good results. The 
tremors of chronic alcoholism have, it is said, been removed by it. 
One of the forms of sick-headache — that occurring at or about the 
menstrual period — is sometimes greatly relieved by its timely exhibi- 
tion. An ointment of picrotoxin — ten grains to an ounce of simple 
ointment — has been applied with success to the treatment of para- 
sitic skin-affections. Care is necessary, and abraded surfaces must be 
avoided. 

A saturated tincture of cocculus Indicus might be employed in place 
of picrotoxin. Planat recommends a tincture composed of one part 
of the berries to four parts of alcohol, and of this one drop is the ini- 
tial dose, morning and evening, increased daily by the addition of two 
drops, up to sixty or seventy drops for an adult, daily. In the diseases 
for which it is prescribed, it is necessary, to secure curative effects, that 
the physiological action be produced. Planat has used this tincture 
successfully in chorea, epilepsy, eclampsia (infantile), and in painful 
contractures of the extremities. Gubler advises the dose of a mille- 
gramme of picrotoxin for subcutaneous use. He has observed that 
indurated spots result from the injections, but they slowly disappear. 

Authorities referred to : 

Browne, Dr. Crichton. The British Medical Journal, vol. i, 1875, pp. 409, 443, 
476, 540. 



408 EXCITO-MOTORS. 

Chirone and Testa. Annali. Univ. di Med. e Chirurg. Quoted in London Med. Rec- 
ord, October 15, 1880. 

Dujardin-Beaumetz. Annuaire de Therap. for 18*76, p. 33. 

Gubler, Prof. A. Bull. General de TJierap., 1875. 

Hammond, Dr. W. A. St. Louis Clinical Record, October, 1876. 

Hurd, Dr. Michigan Med. News, February 10, 1881. 

Kohler, Prof. Dr. Berl. klin. WocJienschrift, No. 47, 1867. 

Hurrell, Dr. William. The Practitioner, October, 1879, vol. xxiii, p. 241. 

Planat, Dr. Bull. Gen. de Therap., 1876. Also Annuaire de Therap., 1876, p. 29. 

Roeber, Dr. Archiv fur Physiol., etc., for 1869, p. 30. 

Ergota. — Ergot. The sclerotium of Claviceps purpurea, replacing 
the grain of Secale cereale Linne (Nat. Ord. Graminacece). (U. S. P.) 
Ergot de seigle, Fr. ; Mutterkorn, Ger. 

Extractum JErgotce Fluidum. — Fluid extract of ergot. Dose, 3 ss 

-Si- 

Vinum Ergotce. — Wine of ergot. Dose, 3 j — f ss. 

Ergotin. — This preparation must not be confounded with a con- 
stituent of ergot, supposed to be an active principle. The ergotin of 
the shops gets its name from "Bonjean's ergotin." It varies very- 
much in strength, owing to faulty modes of preparing it, and is 
not unfrequently inert. As prepared by Squibb it is entirely soluble 
in water, and represents the powers of the drug. Ergotin (the aque- 
ous extract) is the most eligible preparation for hypodermatic injec- 
tion. From one to five grains may be injected at one time. In pre- 
paring it for this purpose, the quantity to be injected should be rubbed 
up with fresh distilled or rain water, and then passed through the filter. 
It is always better to prepare it whenever required. If it is necessary 
to preserve the solution, the addition of a little carbolic acid — one grain 
to four ounces — will usually suffice. The addition of glycerin is not 
necessary, unless added as a preservative fluid ; and is objectionable, 
because it greatly increases the pain which attends the subcutaneous 
injection. 

Composition. — Some confusion yet exists in regard to the con- 
stituents of ergot, notwithstanding recent advances in our knowledge. 
An unfortunate nomenclature is in part responsible for the confusion ; 
but the complexity of the subject and the conflicting views of chemists 
are the chief causes of the present condition of the pharmaceutical 
knowledge of ergot. 

Ergot contains about thirty per cent of a saponifiable, non-drying 
oil, with which is associated a small quantity of resin and cholesterin. 
When extract of ergot is treated with an alkali, a peculiar fishy odor 
is developed, due to methylamine, according to some authorities, and 
trimethylamine according to others. Ergot also contains lactic and 
phosphoric acids and phosphates. The two principles, ecbolina and 
ergotina, separated by Wenzell in 1864, are not true alkaloids of ergot, 
and are said by Dragendorff to be identical. In 1830 a supposed al- 



ERGOT. 409 

kaloid was obtained by Wiggers, which he named ergotin, but this is 
not the true active principle. Unfortunately, an aqueous extract, pre- 
pared by Bon jean, was also named ergotin. Kohler has examined the 
ergotin of Wiggers and that of Bonjean, and finds that they are 
mixtures : the former containing the ingredients of ergot not soluble 
in water ; the latter, those that are soluble in water. According to 
Kohler, neither of these so-called ergotins represents the properties of 
ergot. More recently Dragendorff and Podwissotzky have gone over 
the chemistry of ergot anew, with different results. They have in- 
troduced new terms also, which add to the complications. The most 
important principles obtained by them are sclerotic or sclerotinic acid, 
and scleromucin, the former existing in good ergot in tbe proportion 
of about four per cent, and the latter, two to three per cent. They have 
also separated other principles and secondary products, named re- 
spectively sclererythin, scleroidin, scleroxanthin, and sclerocrystallin. 
Another alkaloid has lately been discovered by Tanret, to which he 
has given the name ergotinine. This substance seems to be the nearest 
approximation to a genuine alkaloid of any hitherto proposed. It is 
a white, crystallizable solid, insoluble in water, and soluble in ether and 
chloroform. It is alkaline in reaction and has strong basic proper- 
ties, and combines with acids to form salts. It is an unstable sub- 
stance, and in the air soon decomposes. 

Antagonists and Incompatibles. — The caustic alkalies and the 
metallic salts are chemically incompatible. Aconite, veratrum viride, 
tobacco, lobelia, and amyl nitrite (Shafer), antagonize the action of er- 
got on the circulation. 

Synergists. — Electricity, cold, digitalis, belladonna, are synergistic 
as regards the vascular system. Savin, gossypium, rue, borax, increase 
its parturient action. 

Physiological Effects. — In small medicinal doses ergot does not 
produce sensible physiological effects. In large doses it causes symp- 
toms referable to the gastro-intestinal canal, and to the cerebro-spinal 
axis. It is bitter to the taste, and excites more or less heat and dry- 
ness of the throat, followed by thirst, stomach-pain, vomiting, intesti- 
nal pain, and occasionally purging. These gastro-intestinal symptoms 
are unquestionably due to the local irritant action of the drug ; for, 
after death, in a few fatal cases which have resulted from its adminis- 
tration, there have been found patches of inflammatory redness in the 
stomach and intestines. 

The active constituents of ergot diffuse into the blood. What 
changes, if any, are caused in the composition of the blood, are at 
present quite unknown. Very characteristic effects are, however, pro- 
duced in the circulatory system : the action of the heart becomes 
slower, and an enormous rise takes place in the blood-pressure. This 
influence on the circulatory system modern research has shown to be 



410 EXCITO-MOTORS. 

due to the action of ergot on the vaso-motor nervous system ; it increases 
the action of this system, and causes a contraction of the arterioles. 

The dilatation of the pupil which follows is another evidence of 
this action. Pain in the head (usually frontal), dimness of vision, 
giddiness, and stupor, are also produced by it. The action of ergot 
on unstriped muscular fiber is further shown in the contractions of the 
parturient womb, the arrest of haemorrhage, and the difficulty of mic- 
turition, which follows its medicinal administration. The power of 
ergot to contract the arterioles has been repeatedly demonstrated in 
the web of the frog's foot. 

The phenomena above described, due to the administration of large 
medicinal or toxic doses, are known as acute ergotism. The peculiar 
morbid effects of ergot, when used for a long period of time as food 
(diseased grain), are known as chronic ergotism, which exists in two 
forms, the convulsive and gangrenous. Generally the convulsive form 
begins by vertigo, disorders of vision, tinnitus aurium, numbness of 
the fingers and toes, and afterward of the integuments of the body. 
These symptoms are followed by tetanoid contractions of the fingers, 
of the forearms on the arms, and of the arms against the chest ; of 
the toes on the palmar surface of the foot, of the leg on the thigh. 
The thoracic, abdominal, and diaphragm muscles are also tetanically 
contracted, and respiration becomes painful and difficult, and attacks 
occur similar to asthma. The intestinal muscles become affected by 
cramp, doubtless tetanoid in character, colics ensue, and diarrhoea ; the 
uterus in pregnant females takes on action, and abortion may result. 
The pulse is small, action of heart slow, and the surface cold. The 
appetite is generally ravenous. 

The tetanic spasms, at first separated by distinct intervals, become 
continuous, and opisthotonos or emprosthotonos is produced. Anaes- 
thesia (complete) of the surface succeeds to the tetanoid attacks, and 
gangrene of limited spots may occur. The organs of sense lose their 
sensibility and taste, hearing and smell are abolished. The pupils are 
dilated, sometimes unequal, and various disturbances of vision ensue. 
Epileptiform convulsions may occur in addition to the tetanoid spasms, 
delirium sets in, and complete insensibility at last supervenes. 

As has been shown by Lasegue and Tardieu, the gangrenous and 
convulsive forms of chronic ergotism are not separated by any well- 
marked pathological differences. The gangrenous form begins by 
tingling, numbness, formication, an insupportable sense of fatigue in 
the members, an earthy hue of the skin, coldness of the surface ; 
nausea, vomiting, and diarrhoea, with intestinal cramps, then occur ; 
muscular contractions take place ; an eruption of vesicles filled with 
a dark ichorous fluid appears on one or more extremities, and gan- 
grene, dry or moist, quickly destroys the toes, the legs, the nose, or 
other parts. 



ERGOT. 41 X 

The phenomena of chronic ergotism are evidently due to two causes 
— to the dyscrasia which exists in the subjects of this malady, owing 
to insufficient food and bad hygienic surroundings, and to the action 
of the ergot of the diseased grain, in diminishing the blood-supply to 
the cerebro-spinal axis, to the vegetative organs, and to the skin and 
muscular system. 

To this general sketch of the actions of ergot, it may be well to 
add some particulars of its most important physiological properties, 
and some observations on the actions of the recently discovered active 
principles. The most conspicuous effect of ergot, and that on which 
depends its therapeutical applications, is the influence which it exerts 
over the vascular apparatus. It is an undoubted fact, in respect to 
which all the investigators agree, that ergot diminishes the number 
and alters the character of the cardiac pulsations. The frog's heart 
may be arrested in the diastole by the intravenous injection of a full 
dose. By Rossbach and Wernich it was observed that a vermicular 
or peristaltic motion was given to the heart of frogs. The arrest of 
the heart's action is attributed by Eberty to stimulation of the vagus 
and a consequent increase of the inhibition. By Rossbach it is referred 
to an action on the cardiac muscle. It is in a high degree probable, 
however, that the slowing and depression of the cardiac functions is 
due to the action of ergot on the cardiac ganglia. To this may be 
opposed the observation of Willebrand, that the normal or hyperto- 
phied heart so contracts under the action of ergot that the difference 
in size is appreciable by percussion ! There is no dispute in regard to 
the contraction of the arteries induced by ergot. It has been observed 
and measured by Wernich, Briesemann, and Holmes. The notion that 
ergot causes contraction of the arteries by stimulating the vaso-motor 
system and its muscular apparatus has long been entertained. An 
enormous rise in the blood-pressure has been stated to occur by Eberty, 
Kohler, and H. C. Wood, and their opinion was based on kymographic 
observations. Holmes, Hermann, and Wernich, on the other hand, 
maintain that the blood-pressure is actually reduced. Wernich shows 
that the veins are dilated, and that a great accumulation of blood takes 
place in them, while, at the same time, the arteries contract, not re- 
ceiving from the slowly acting heart sufficient blood. The contrac- 
tion of the arteries is not, therefore, an active contraction, as has been 
supposed, but a collapse, the result of deficient supply of blood, which 
has accumulated in the dilated veins. By the theory of vaso-motor 
stimulation, it was easy to explain the action of ergot on the muscular 
fiber of the uterus and intestinal canal. If, however, the blood-press- 
ure falls after the administration of considerable doses, as Handelin, 
Brown-Sequard, and others affirm, and the arterial contraction is 
not active, how explain the uterine and intestinal action of ergot? 
This result is due to arterial ansemia (Wernich, Schlesinger, Mayer, 



412 EXCITO-MOTORS. 

etc.). It is now clearly established that active movements occur in 
the muscular fiber of the intestinal canal and uterus by inducing an 
arterial anaemia. According to this view, then, the active peristalsis 
and the uterine contractions which follow the exhibition of ergot are 
the result, not of a direct stimulation of the sympathetic system, but 
of the diminished cardiac energy, dilatation of the veins, and arterial 
anaemia. 

The action of ergot is not limited to the vascular apparatus. The 
arterial anaemia which it induces may serve to explain the cerebral 
effects which follow its free administration in man, but, besides these, 
the functions of the spinal cord and peripheral nerves undergo changes. 
In frogs ergot induces paralysis, beginning in the hind extremities, 
and thence involving all parts, the circulation and respiration being 
the last to yield. In warm-blooded animals the same effects are pro- 
duced, and, if the action continues, finally the cardiac and respiratory 
centers are paralyzed. By Zweifel these central effects are held to 
be the principal, and all others merely secondary. On the other hand, 
the depression in the motor and reflex functions of the cord may be 
explained by the arterial anaemia, which is an undisputed effect of 
ergot, how much soever the mechanism of its production may be dis- 
puted. Indeed, it must be admitted that the actions of ergot are still 
subjudice. The numerous and often diverse views which have been 
expressed may be in part explained by the character of the prepara- 
tions. There can be no doubt that the active constituents are un- 
stable, and hence the pharmaceutical products vary, not only in the 
degree, but decidedly also in the character, of the actions. In Koh- 
ler's investigation, in which he compared the ergotin of Wiggers and 
Bonjean, there were very wide differences between them. The ergotin 
of Bonjean — an aqueous extract — excites the vaso-motor center in the 
medulla and the cardiac inhibitory center, and very large doses para- 
lyze the heart, the muscular tissue losing its excitability to galvanism. 
Wiggers's ergotin has no effect on the vascular apparatus. In these ex- 
periments of Kohler, with which Eberty was associated, the power of 
ergot to increase the blood-pressure is an important point. The atten- 
tive reader will observe that in these experiments the heart was para- 
lyzed, and the irritability of its muscular tissue destroyed. Wiggers's 
ergotin causes cramps of the intestines, and violent inflammation of 
the gastro-intestinal mucous membrane, effects which never result 
from Bon jean's. Both kinds of ergotin lower the temperature, and 
both retard the respiration. Bonjean's ergotin diminishes the irri- 
tability of the peripheral motor nerves, and Wiggers's increases it. 
Both lessen the irritability of the sensory nerves. Kohler concludes 
that, when it is desired to slow the heart, contract the vessels, dimin- 
ish reflex actions, and lessen temperature, the ergotin of Bonjean 
should be used. 



ERGOT. 413 

The physiological action of sclerotinic acid has been carefully 
studied by Nikitin in Rossbach's laboratory. He starts out by affirming 
the identity of action between this principle and ergot. In frogs the 
reflex excitability of the spinal cord is reduced, then destroyed, but 
in warm-blooded animals it is reduced only. It does not affect the 
irritability of the motor nerves, nor the contractility of the muscles, 
but when brought in contact with sensory nerves, paralyzes them. 
Sclerotinic acid depresses the action of the heart in frogs, but not in 
mammals. In toxic doses it lowers the blood-pressure and reduces 
the temperature. The respiration is slowed, and, when toxic doses 
are given, the movements of respiration cease before the heart stops. 
The peristaltic movements are increased in warm-blooded animals, 
and the uterus, whether gravid or not, is excited to action. Death is 
due to paralysis of respiration. 

Sclerotinic acid has been freely prescribed by Yon Hoist, who finds 
it possessed of a high degree of activity, but other clinicians have 
been less successful — thus Robert, of Halle, finds it can not be substi- 
tuted for ergot. In my own experiments, I have found it produce 
effects, but not those of ergot proper. Sclerotinic acid is separated by 
alcohol, but Handelin, who had investigated this subject under the 
superior direction of Schmiedeberg, finds that ergot loses none of its 
activity by being extracted with alcohol. Handelin's experiments, 
made with an aqueous extract, present some points of interest. He 
found that small doses cause anaesthesia and impair the power of co- 
ordination, and large doses paralyze reflex and voluntary motions. As 
the peripheral nerves are unaffected, the paralysis is centric. Small 
doses lower the blood-pressure temporarily, and large doses perma- 
nently. The pulse is at first quickened, and then declines, becoming 
more and more slow until the heart is arrested. 

The first trials with Tanret's crystallized ergotinine were made by 
Dr. Mole, who found it as effective in uterine haemorrhage as ergot. 
The amount that he administered did not exceed four milligrammes 
in twenty-four hours. Galippe and Budin have also experimented with 
ergotiniue on frogs, cats, and dogs, and produced many of the effects 
ascribed to ergot, namely, slowing of the pulse, reduction of tempera- 
ture, paralysis, and convulsions. Peton, another investigator, has also 
experimented with ergotinine, the results of the action being contrac- 
tion of the arteries, restlessness, trembliug, diarrhoea, etc. 

An examination of the results obtained from the experimental and 
clinical trials with the so-called principles and alkaloids of ergot dem- 
onstrates that in no single one are contained all the powers and prop- 
erties of the drug. It is also evident that ergot, and those principles 
possessing its powers most nearly, depress the heart, and lower rather 
than elevate the tension of the arteries. The contraction of the ar- 
teries is not, therefore, an active contraction ; and, as the blood accu- 



414 EXCITO-MOTORS. 

mulates in the veins, there is an anaemia of the cerebro-spinal axis and 
of the organic muscular fiber. To this condition of things may be 
referred the phenomena resulting from the exhibition of ergot. 

Therapy. — The only diseases of the intestinal canal to which ergot 
is applied are chronic diarrhoea and dysentery. It is best adapted to 
those cases in which the chronic succeeds to the acute form, and is not 
so serviceable in the chronic diarrhoea of warm climates, which has de- 
veloped slowly, without preliminary acute symptoms. $ Ext. ergotae 
fluidi, f iijss; tinct. opii deodor., \ ss. M. Sig.: A teaspoonful three 
times a day. ^ Ergotinae (aq. ex.), 3j ; ext. nucis vomicae, gr. v ; 
ext. opii, gr. v. M. Ft. pil. no. xx. Sig. : One every four or six 
hours. This last prescription is highly useful in persistent chronic 
diarrhoea. 

Dr. L. G. Andrew has treated acute dysentery successfully with 
the fluid extract of ergot. Dr. W. C. Dabney, of Virginia, urges the 
local application of fluid extract of ergot in affections of the mucous 
membrane characterized by enlarged vessels, as, conjunctivitis, cervi- 
citis, pharyngitis, etc., and by Dr. Eldridge it has been applied to the 
treatment of gonorrhoea, acne rosacea, etc. The theory of its action 
in these maladies is the artificial anaemia which it induces in the arterial 
vessels. Inflammation can not go on, because the blood-supply is in- 
adequate. In the local application the fluid extract of ergot is used. 
In most cases this may be applied directly to the membrane undiluted. 
The aqueous extract, or ergotin, may be utilized for these purposes 
also ; made into a paste more or less thick according to the character 
of the surface, it may be plastered on the affected part. 

Ergot in the form of the fluid extract, with or without nux-vomica, 
will often arrest the bleeding of haemorrhoids, and cause such a con- 
traction of the vessels in recent cases as that the symptoms may en- 
tirely disappear. This treatment is especially serviceable in the haemor- 
rhoids which succeed to delivery. Relaxation of the sphincter ani and 
prolapsus of the rectum may be ameliorated and, when recent, cured 
by the same means. 

Ergot is a useful remedy in cases of enlarged heart (dilated cavities) 
without valvular lesion. It may be given with digitalis : I£ Ext. 
ergotae fluidi, f iijss ; tinct. digitalis, f ss. M. Sig. : A teaspoonful 
three times a day. There is now no longer any doubt as to the value 
of ergot in aneurisms, and especially in internal aneurisms beyond the 
reach of surgical treatment. In these cases the methodus medendi is 
as follows : ergot slows the action of the heart, and causes such a de- 
gree of contraction of the arterioles as to produce a great increase of 
the blood-pressure, whence it follows that the coagulation of the blood 
in the aneurismal sac is greatly promoted. It is quite conceivable that, 
as respects small aneurisms of the peripheral main arterial trunks, 
ergot may effect a cure in the mode suggested by Langenbeck, viz., 



ERGOT. 415 

by direct contraction, under the influence of the ergot, of the unstriped 
muscular fibers in the affected portion of the vessel. "With the use of 
ergot should be enjoined rest in the recumbent posture, and other 
measures to favor hyperinosis and the coagulation of the blood in the 
aneurismal sac. 

The recent, more accurate notions, regarding the physiological ac- 
tion of ergot, have led to its employment in various forms of hemor- 
rhage. With suitable means for improving the quality of the blood, 
ergot is very serviceable in the hemorrhagic diathesis ; but it is not 
to be relied on alone. The special indication for its use in haemorrhage 
is a want of tonicity of the vessels. It is used in epistaxis, hmmopAysis, 
renal, intestinal, and uterine hemorrhage. Large doses of a suitable 
preparation are necessary ; for, if the drug be inert, nothing but dis- 
appointment will be experienced from its use, and small doses do not 
produce sufficient effect. From half a drachm to a drachm of the pow- 
dered ergot, or one to two drachms of the fluid extract, given every 
half-hour or hour, will be necessary in urgent cases. As powdered er- 
got rapidly loses its activity by keeping, the fluid extract should be 
used, and only that prescribed which has been carefully made from the 
fresh drug. Attention to these precautions will insure more uniform 
results in hemorrhage than have hitherto been obtained. In hemop- 
tysis the fluid extract of ergot may be given with other appropriate 
remedies ; $ Ext. ergotae fluidi, § iij ; ext. ipecac, fluidi, tinct. opii 
deodor., aa 3 ss. M. Sig. : A teaspoonful every half -hour or hour. 
When the sputa are heavily charged with blood, and there is no de- 
fined haemorrhage, the following may be used : ^ Ergotinae (aq. ex.), 
3] ; pulv. ipecac, gr. x ; acid, gallic, 3 j. M. Ft. pil. no. xx. Sig.: 
One every hour or two. In renal hemorrhage, the following is a use- 
ful formula and generally very effective : I£ Ext. ergotae fluidi, tinct. 
krameriae, aa § ij. M. Sig.: A teaspoonful every hour or two. Or, 
ergotine may be prescribed with gallic acid, as in the prescription above 
given. 

The indication for the use of ergot in menorrhagia is the existence 
of the large, spongy uterus — the condition of things which depends on 
subinvolution of the icomb. Menorrhagia, when caused by ovarian 
excitement, is usually more promptly relieved by bromide of potas- 
sium, and metrorrhagia, produced by fibroids or fungous granulations, 
is, in the author's experience, much more decidedly held in check by 
diluted sulphuric acid than by ergot. 

When there is reason to believe that vertigo, epistaxis, headache, 
and tinnitus aurium, are due to miliary aneurisms of the intra-cranial 
arterioles, most favorable results can be produced by the use of ergot. 
Also, when there is a sluggish and partially obstructed state of the 
intra-cranial veins, usually due to chronic arteritis, and accompanied 
by hebetude of mind, giddiness, epistaxis, etc, these symptoms are 



416 EXCITO-MOTORS. 

made to disappear, and the mental condition is much improved by 
ergot. 

Dr. Crichton Browne, a physician of large experience in these dis- 
orders, finds ergot a very useful remedy in certain forms of mental 
disease, for example, " in recurrent mania, chronic mania with lucid 
intervals, and in epileptic mania." In these mental disorders he as- 
sumes the existence of cerebral hyperemia, and he deduces the cura- 
tive value of ergot from its power to cause contraction of the vessels. 

Migraine, when the attacks are accompanied by suffusion of the 
face, injected conjunctivae, and a full pulse — the congestive form — is 
cured by ergot, and Dr. Kitchen indeed extends its use to almost all 
kinds of headache. 

In epidemic cerebrospinal meningitis, ergot is one of the remedies 
from which the best results are to be expected. In congestion of the 
spinal meninges and the cord, and in acute myelitis, this remedy has 
probably been more uniformly successful than any other, but it must 
be given in large doses. 

Excellent results have been obtained from the use of ergot in acute 
inflammation of the conjunctiva, in blepharitis, and in the phlyctenu- 
lar ophthalmia of children. 

The long-continued use of ergotin has achieved remarkable results 
in chronic metritis. Uterine fibroids and polypi of the uterus are 
greatly benefited in two modes by ergot : uterine action is set up, by 
which the growth is either compressed or extruded, and the nutrient 
vessels are so diminished in caliber that atrophy of the morbid growth 
occurs. The numerous reported instances of success by this treatment, 
and the author's personal experience of its utility, justify him in urging 
a trial of this remedy in uterine fibroids and polypi. 

In congestive dysmenorrhea, much good may be expected from the 
use of ergot when the menstrual molimen begins. $ Ext. ergotse 
fluidi, 3 vij ; tinct. gelsemii, 3 j ; tinct. aconiti rad., gtt. xvj. M. 
Sig. : A teaspoonful every two, three, or four hours. Amenorrhoea, 
when dependent on plethora, has been cured by ergot. 

When incontinence of urine, nocturnal or diurnal, is caused by a 
paretic or paralytic state of the sphincter vesicce, relief may be confi- 
dently expected from the use of ergot. The fact that one of the ill 
results of the administration of ergot in large doses is an inability to 
void the urine, is an interesting explanation of the methodus medendi 
of ergot in these cases. 

Ergot is one of the most satisfactory remedies in the treatment of 
spermatorrhoea. It is not useful when the losses are due simply to 
plethora. Its curative value is especially exhibited in those cases in 
which the erections are feeble and infrequent, the intromittent power 
wanting, and the testes relaxed and deficient in secretory activity. 

Paralysis of the bladder, the result of over-distention, and occasion- 



ERGOT. 417 

ally when due to cerebral or spinal lesion, is greatly benefited or cured 
by ergot. 

Ergot was first employed by Da Costa in the treatment of diabetes 
insipidus, and a number of cases have been cured by Murrell, Saun- 
ders, and others. The remedy must be perseveringly used, and in full 
doses, up to the stomach capacity or evidence of physiological action. 

Heitzmann has found ergot extremely useful in acne rosacea, and 
other forms of acne. He uses Squibb's fluid extract of ergot mixed 
with glycerin and water, giving 3 ss internally, daily. 

Ergot in Obstetric Practice. — It is no longer a matter of doubt 
that ergot promotes uterine contractions ; that it originates them with- 
out previous effort of the womb, is questionable. The contractions 
due to ergot differ from the spontaneous, natural contractions, in being 
less rhythmical and more tetanic. When large doses of ergot are used, 
a continuous expulsive effort may be produced. Ergot is indicated in 
labor when there is uterine inertia, the first stage being completed, 
and no obstacle existing at the outlet. If given before dilatation is 
completed, the perinaeum rigid, and the ostium vaginoe not relaxed, dis- 
astrous consequences may ensue, both to mother and child. On the 
part of the mother, the violent and continuous pains — the resistance in 
front remaining — may cause a rupture of the womb, or the resistance 
may be overcome by laceration of the perinaeum. On the part of the 
child, it arrests haematosis, partly by direct action on the placental 
blood, and partly by the continuous compression of the body ; but the 
chief danger is paralysis of the foetal heart. 

It is highly approved by obstetricians at the present time to admin- 
ister a dose of ergot at the conclusion of the second stage of labor, to 
insure firm uterine contractions. This practice is held to be the more 
necessary when previous experience justifies the apprehension of trou- 
blesome haemorrhage. When post-partum hmmorrhage occurs, it is 
universally conceded to be the proper thing to administer a full dose 
of ergot ; but at the same time other measures must be resorted to in 
order to procure firm uterine contractions, on which alone depends the 
safety of the patient. In these conditions the ergot is usually admin- 
istered in substance — one scruple to a drachm of coarsely-powdered 
ergot infused in a cup of hot water, the whole being drunk by the pa- 
tient. From 3 j to § j of the fluid extract may be given instead — the 
official preparation representing a grain of ergot to the minim. 

The Hypodermatic Injection or Ergotin. — The subcutaneous 
injection of ergot has become so important a therapeutical resource 
that it is necessary to treat the subject in a separate division. The 
solution employed for this purpose is usually as follows : ^ Ergotinae 
(aq. ex.), 3 j ; glycerini, 3 j ; aquae destil., 3 vij. M. Sig. : Eight 
minims contain one grain of ergotin. Squibb has prepared " an ex- 
tract of ergot which is almost entirely soluble in cold water, and rep- 
27 



418 EXCITO-MOTORS. 

resents good rye ergot in the proportion of one grain of extract for 
five grains of ergot. Sixty grains of this extract, dissolved in two 
hundred and fifty minims of water — the solution filtered, and made up 
to three hundred minims by passing water through the filter to wash 
it and the residue upon it — makes a solution which represents ergot in 
the proportion of minim for grain, and is of the same strength as the 
fluid extract of ergot, but is free from alcohol or other irritant sub- 
stance." This preparation the author has found to be admirably 
adapted for subcutaneous administration. When the aqueous extract 
of ergot of good quality can not be obtained, the fluid extract may be 
used. 

The rules for the administration of ergot are the same as for other 
agents applied in this way. 

In the treatment of haemorrhage, when a prompt effect is desired, 
the hypodermatic injection is preferable to the stomach administration. 
In haemoptysis, the injection may be practiced while suitable remedies 
are administered by the stomach. In hmmatemesis, especially if the 
stomach be irritable, better results may be obtained by subcutaneous 
use of ergot than by any form of internal medicine. In post-partum 
haemorrhage , when to await the action of ergot may endanger the life 
of the mother, the subcutaneous administration should be resorted to. 
The happy results which have attended this mode of administration 
in serious cases, demand that the accoucheur be provided with the 
necessary appliances for the hypodermatic injection of ergot in every 
obstetrical case. This mode of using ergot is not only prompter in 
results, but is more effective in securing uterine contractions and arrest 
of haemorrhage. 

The good results which are obtained from the stomach administra- 
tion of ergot in subinvolution of the uterus and in chronic metritis, 
are much more quickly and decisively obtained from the subcutaneous 
administration. Since the memoir of Hildebrandt appeared, numerous 
cases of successful treatment of uterine fibroids by hypodermatic injec- 
tion of ergotin have been published. There seems to be no longer 
any doubt that this agent administered in this way, and less effectively 
and for a much longer period by the stomach also, has the power to 
arrest the growth of uterine fibroids, to cause them to atrophy, or to 
set up such a degree of uterine action as to compel their extrusion as 
polypi from the uterine cavity. It has, of course, long been known 
that ergot administered by the stomach may induce such a degree of 
uterine contraction as to expel a polypus. In those instances in which 
the hypodermatic injection fails to arrest the growth of a polypus, 
notable improvement in the amount of the haemorrhage and of the 
muco-purulent discharge is, at least, a result of the treatment. The 
author is enabled to speak from personal observation of the excellent 
results obtained by this mode of treatment in many cases. 



ERGOT. 419 

From two to six grains of the aqueous extract of ergot (ergotin) 
may be injected under the skin in these cases of uterine fibroids on 
alternate days, or thrice or twice each week. The abdomen is usually 
preferred as the site of the injection. More or less pain is experienced 
at the moment of the insertion of the solution, and an indurated spot, 
which may be more or less sore, will remain for a week or more. Sup- 
puration may result from the injection, but it is not a frequent accident. 

The hypodermatic injection is an effective mode of treating vari- 
cocele. About two grains of the extract in solution is a suitable dose. 
The needle is inserted so that its point will rest among the dilated 
veins, but care must be taken not to puncture a vein. Very severe 
pain follows, and there may be great faintness, but the effects subside 
in a few hours unless considerable swelling should ensue, which is 
quite usual. A single injection may cure a very extensive varicocele, 
and more than two are rarely necessary. Varicose veins in other 
parts, especially of the inferior extremities, have been cured by the 
same treatment. The following is the mode of proceeding in these 
cases : the needle is inserted under the skin, in close juxtaposition to 
the enlarged vein, and the fluid is so injected as to lie alongside of the 
vein, but not to enter it. The cure which follows in many of these 
cases has been ascribed to the inflammatory swelling which takes place, 
but there is, doubtless, besides this effect, a dynamical influence ex- 
erted on the vessel-walls. 

It has lately been asserted that deficient erections and loss of the 
capacity for coitus are not unfrequently due to enlargement of the 
dorsal vein of the penis, and consequent too rapid emptying of the 
veins of the erectile tissue. Acting upon this plausible suggestion, the 
author has practiced the hypodermatic injection of ergotin about the 
dorsal vein of the penis, and he has had apparently excellent results. 

Before closing this article, it may be advisable to recall to the read- 
er's attention the fact that the hypodermatic injection of ergot, or its 
internal administration in large doses, may cause such tonic contrac- 
tion of the sphincter vesical as to render micturition impossible. Care- 
ful inquiry and frequent examinations of the hypogastric region should 
be made during a course of ergot preparations. 

Authorities referred to : 

Bailly. Prop. M. Ergot, Ergotine— Action physiologique, etc. Bulletin General de 
Therapeutique, vol. lxxviii, pp. 433, 481, 529. 

Bartholow, Dr. Roberts. Manual of Hypodermatic Medication, fourth edition, arti- 
cle Ergotin. 

Briesemann, Dr. C. Schmidt's Jahrbucher, vol. cliii, p. 30. 

Browne, Dr. Crichton. Tlie Practitioner, vol. vi, p. 321. 

Cyr, Dr. Jules. Traite de V Alimentation, Paris, 1869, article Ergotisme, p. 425, 
et seq. 

Dutoit, Dr. Schmidt's Jahrbucher, vol. cliv, p. 315. 

Eberty, Dr. P. Schmidt's Jahrbucher, vol. clviii, p. 126. 



420 EXCITO-MOTORS. 

Eulenburg, Dr. Albert. Die hypodermatischen Injection der Arzneimittel, 1867, p. 283. 

Fluckiger and Hanburt. Pharmacographia, p. 672, et seq. 

Hildebrandt, Prop. TJeber die Einwirkung Subcutaner Injectionen von extr. secal. cor- 
nut. aq. auf Fibro-Myome des Uterus. Berliner klinische Wochenschrift, No. 25, 1872, p. 29. 

Holmes, Dr. Ch. L. Schmidt's Jahrbucher, vol. clviii, p. 126. 

Husemann, Drs. Theo. und Aug. Die Pjlanzenstojfe ; Alkaloide des Multerkorns, p. 520. 

Husemann, Dr. Theod. Handbuch der gesammten Arzneimittellehre, Berlin, 1875, p. 203. 

Kitchen, Dr. Daniel. The American Journal of Insanity, July, 1873. 

Langenbeck, Prof. Berliner klinische Wochenschrift, No. 6, 1869. 

Luton, Dr. A. Gazette Hebdomadaire, October, 1871. 

Meadows, Dr. Alfred. The Practitioner, September, 1868. 

Nicol, Dr. Patrick, and Isaac Mossop. On the Action of Certain Neurotics on the 
Cerebral Circulation. British and Foreign Medic o-Chirurgical Review, July, 1872. 

Schneider, Dr. Berliner klinische Wochenschrift, vi, 36, p. 390. 

Ustilago. — Ustilago. Ustilago maydis Leveille (Nat. Ord. Fungi) 
grows upon Zea mays Linne (Nat. Ord. Graminacece). (TJ. S. P.) 

JExtractum Ustilaginis Maydis Fluidum. — Fluid extract of usti- 
lago. Dose, Tii x — 3 j. 

Composition. — No proper investigation has yet been made of the 
chemical constitution of ustilago. Some of the ingredients found in 
ergot have been detected, as secaline so called, and trimethylamine ; 
but the latter is regarded by others as a decomposition product and not 
existing preformed. Besides other substances, Parsons has separated 
an acid, which he regards as similar to the sclerotic acid of Dragen- 
dorff, and a substance soluble in ether but not in alcohol. 

Physiological Actions. — Ustilago has been made the subject of 
physiological investigation by Mr. (now Dr.) Ripley C. Hoffman, of 
Iowa, in the laboratory of experimental therapeutics of Jefferson Medi- 
cal College, under the supervision of the author. The research em- 
braced cold- and warm-blooded animals. The preparation used was 
the fluid extract, made by John Wyeth and Brother, of Philadelphia, 
and it proved to be quite active. Both in cold- and warm-blooded 
animals, ustilago acts as a spinal excitant, causing convulsions of a 
tonic character. It also heightens sensibility and the reflex function, 
so that the least irritation of the skin induces general tonic convul- 
sions of the tetanic or strychnic character. Frequent irritation and 
repeated convulsions rapidly exhaust the animal. On the other hand, 
quiet, darkness, and relief from all irritation, diminish the severity of 
the convulsions, and prolong life, if not prevent a fatal result. Death 
may ensue in a convulsion by tetanus of the respiratory muscles. 
Muscular tremors, general, occur in warm-blooded animals, and mus- 
cular weakness (paresis) appears in the intervals between the convul- 
sions. The irritability of the motor nerves, and toward the end, of the 
sensory nerves also, declines, but is not entirely lost, and the contrac- 
tility of the muscles lessens somewhat. That the convulsions are 
spinal, is a fact proved by destroying the cord in a frog, before admin- 



DIGITALIS. 421 

istering the medicament, when no muscular action of any kind takes 
place. Section of the medulla or decapitation does not prevent the 
occurrence of the convulsions. 

Ustilago slows the heart, and by numerous control experiments this 
action was shown to be due to stimulation of the pneumogastric and 
its terminal ganglia. It dilates the pupil, and affects the acuteness of 
vision for near objects. 

We have no exact data in regard to the action of this agent on the 
uterine system. An impregnated cat, dying by a merely lethal dose 
slowly, did not abort ; but it is said that pregnant cows and bitches, 
after eating ustilago, have dropped their young. 

The modes of dying are two : in the tetanus ; by exhaustion. In 
the former, the respiration is arrested, violent tonic extension of the 
voluntary muscles takes place, the head being drawn back, the toes 
incurved. In the latter, there is gradually increasing paresis between 
the convulsions, and slowing of the heart's action. The difference is 
largely due to the dose and rapidity of administration. A lethal dose 
for a rabbit weighing 25 ounces seems to be one drachm of the fluid 
extract. 

Therapy. — If Dr. Hoffman's study of the action of the fluid extract 
be confirmed by others, ustilago must occupy an important position 
as a remedy, possessing as it apparently does the powers of nux-vomica 
and of ergot combined. It is indicated in the several groups of cases 
to the treatment of which these remedies are now applied. 

Digitalis. — The leaves of Digitalis purpurea Linne (Nat. Ord. 
Scrophulariacew), from plants of the second year's growth. (U. S. P.) 
Feuilles de digitate, Fr. ; Eingerhutbldtter, Ger. 

Abstractum Digitalis. — Abstract of digitalis. Dose, gr. ss — gr. j. 

Infusum Digitalis. — Infusion of digitalis contains 3 parts each of 
digitalis and cinnamon, infused in boiling water ; after two hours 
maceration is strained ; then 15 parts of alcohol added, and finally suf- 
ficient water to make up to 200 parts. Dose, 3 ij — § ss. 

Extractum Digitalis Fluidum. — Fluid extract of digitalis. Dose, 
m j— m iij. 

Extractum Digitalis. — Extract of digitalis. Dose, gr. ss — grs. ij. 

Tinctura Digitalis. — Tincture of digitalis. Dose, ra v — 3 j. 

Composition. — Digitalis contains an active principle, digitaline. 
This exists in the amorphous and crystalline form. The amorphous 
form — the digitaline of Homolle and Quevenne — possesses considerable 
activity, and, according to some authorities, is quite equal to the crys- 
talline in strength. The crystalline digitaline (Nativelle's digitaline), 
physiological investigations have shown, is really an active principle 
which represents all of the powers of the drug. This occurs in nee- 
dle-shaped crystals, and has an extremely bitter taste. 



422 EXCITO-MOTORS. 

According to Schmiedeberg, digitalis contains digitonine, which 
strongly resembles saponine ; digitaline, which is insoluble in water, 
and is the chief constituent of Homolle and Quevenne's digitaline ; 
digitale'in, which is readily soluble and has the same action as German 
digitaline ; digitoxine, the most powerful, and is the principal constit- 
uent in Nativelle's digitaline. Koppe has examined the action of digi- 
taline, digitalein, and digitoxine, and finds that they agree in their 
action, and with the crude drug, but differ in degree of activity. 

Digitalinum. — Digitaline. A white, or yellowish-white powder, 
without odor, and having a very bitter taste. Dose, -£$ — ^ of a 
grain. 

Antagonists and Incompatibles. — The cinchona preparations, 
acetate of lead, the sulphate and tincture of the chloride of iron, are 
chemically incompatible. Tannic acid and the preparations containing 
it diminish the physiological activity of digitalis. Opium, aconite, 
lobelia, and the cardiac paralyzers, antagonize some of the actions of 
digitalis, but the antagonism does not extend throughout the whole 
range of their influence. The most complete physiological antago- 
nism exists between digitalis and saponine (KOhler), the active princi- 
ple of Saponaria officinalis, closely allied to senegine. Aconite antag- 
onizes the cardiac action of digitalis, and morphine, also, to a less 
degree. 

Synergists. — Cold, ergot, belladonna, increase the physiological 
activity of digitalis. 

Physiological Action. — Digitalis has a disagreeable, bitter taste. 
In considerable doses, of the infusion, for example, it disturbs the 
stomach and gives rise to nausea and vomiting, and frequently purges. 
Loss of appetite results from its medicinal administration in some 
subjects, even when the quantity is small ; but, in others, the appetite 
is increased. The active constituents of digitalis diffuse into the 
blood, but nothing is definitely known as to the action of this agent 
on the composition of the blood, or the influence which it has, if any, 
on the morphological elements. 

On the heart digitalis exerts a peculiar action which requires atten- 
tive examination : it prolongs the diastole and increases the vigor of 
the systole. A lethal dose arrests the heart in systole, inducing a tetan- 
ic state of the heart-muscle. While digitalis increases the power of 
the systole, the diastole is prolonged, hence the number of pulsations 
per minute is reduced. With ordinary medicinal doses this slowing of 
the heart may be considerable, and the pulsations may descend to fifty 
or even forty per minute. Microscopic examination of the mesentery 
(Ackermann) and of the web of the frog has definitely ascertained 
that a marked contraction of the arterioles takes place under the influ- 
ence of digitalis. The increased power of the systolic contraction of 
the heart and the greatly-increased resistance in front from a narrow- 



DIGITALIS. 423 

ing of the caliber of the vessels produce, as might a priori be ex- 
pected, a considerable rise of the blood-pressure. When the pulse is 
greatly reduced by the administration of large medicinal doses, a 
change from the recumbent to the upright posture causes a remarkable 
increase in the number, and diminution in the force, of the cardiac pul- 
sations. When lethal doses, short of a sudden toxic effect, have been 
experimentally administered, the slowing of the heart and rise of ar- 
terial tension first produced are succeeded by a quick, feeble pulse, and 
fall in the blood-pressure. These results are obviously due to the loss 
of power (paresis) which results from over-stimulation. 

A temporary rise of temperature follows the administration of a 
lethal dose of digitalis, but this rise is soon succeeded by a marked and 
sustained reduction. Owing to the increased resistance from diminu- 
tion of the caliber of the arterioles, the actual energy expended by the 
heart is in part converted into heat. Subsequently the slowing of the 
circulation, especially through the lungs (Traube), hinders the combus- 
tion process, and hence the fall of temperature. 

Digitalis in full medicinal doses produces headache, a band-like feel- 
ing around the forehead, dizziness, disturbances of vision (mistiness, 
vibratory movements of external objects, chromatic dispersion, etc.), 
drowsiness, languor, and a sense of weariness, and it may even cause 
hallucinations, illusion, and delirium. Digitalis lessens the reflex func- 
tion of the cord, lowers the sensibility of the nerves, motor and sen- 
sory, and impairs the electro-contractility of muscles ; but these effects 
are not produced by medicinal doses, but are toxic in character. 

As might be anticipated from a study of its physiological actions, 
digitalis acts like ergot on the enlarged uterus ; it stimulates to ener- 
getic contraction the muscular fibers, and in this way arrests uterine 
haemorrhage. On the genital organs of man it has a similar action ; by 
diminishing the blood-supply to the erectile tissue it lessens the power 
of erections, and, secondarily, affects the venereal appetite, producing 
anaphrodisia. 

Considerable difference of opinion exists as to the influence of digi- 
talis on the function of nutrition — the metamorphosis of tissue. By 
some an increase in the production of urea, by others a diminution, has 
been noted. The truth, most probably, is that it has no real influence 
on urea formation, and that the variations observed are accidental. The 
phosphoric acid and chlorides are diminished. In health digitalis af- 
fects but little the water of the urinary secretion ; according to some 
the water is diminished, according to others increased. It is difficult 
to reconcile these opposing statements, in view of the fact which has 
recently been ascertained by Brunton, that the diuretic action of digi- 
talis in dropsy is not due to the increased blood-pressure, but to a spe- 
cial action on the Malpighian tufts. 

Therapy. — Before entering on the therapeutical applications of 



424 EXCITO-MOTORS. 

digitalis, there are several practical points with regard to the quality 
of the drug which require attention. Disappointment in the use of 
digitalis is frequently experienced, in consequence of the inferior qual- 
ity of the drug prescribed. The wild digitalis is better than the culti- 
vated. In this country much of the digitalis found in the shops is the 
plant cultivated and put up by the Shakers. It is very uncertain, and, 
according to the author's observation, usually inert. The English digi- 
talis, and the preparations made from it, should alone be prescribed. 

Digitalis has an undoubted power to arrest hcemorrhage (Leyden). 
The mechanism of its action is similar to that of ergot ; it slows the 
action of the heart and contracts the arterioles. In hcemoptysis it is 
especially useful in the following state of things : frequent expectora- 
tions of bloody mucus, with occasionally a mouthful of florid blood, 
accompanied by fever. This group of symptoms is dependent on 
transudation from a number of small vessels about the site of a pneu- 
monia due to a tubercular or caseous deposition. The same kind of 
expectoration, due to pulmonary congestion from mitral regurgita- 
tion, is amenable to the same treatment. In uterine hemorrhage digi- 
talis is also serviceable, but it is more especially indicated in menor- 
rhagia and metrorrhagia of plethoric subjects. Like ergot, digitalis 
has the power to induce uterine contractions, and hence it has been 
used successfully to arrest post-partum hemorrhage. Cases of menor- 
rhagia, of a peculiarly obstinate kind, are caused by mitral regurgi- 
tation or stenosis, the mechanical result being to increase the blood- 
pressure in the venous system of the uterus. Digitalis is the appro- 
priate remedy in such cases. Granules of digitaline may be prescribed 
for some days previously to the occurrence of the menstrual molimen, 
but during the attack the infusion of digitalis is more serviceable. In 
cases of haemorrhage, generally speaking, the infusion is the most ef- 
fective form in which to employ digitalis. If the symptoms are urgent, 
a tablespoonful of the infusion may be given every half-hour until 
four doses are taken. In ordinary cases a tablespoonful of the infu- 
sion twice a day is a sufficient quantity to maintain a constant physio- 
logical effect. In the treatment of hemorrhage, digitalis may be 
combined with other remedies which are synergistic. 1^ Infus. digi- 
talis, § ij ; tinct. krameriae, ext. ergot ib fluidi, aa § j. M. Sig. : A 
tablespoonful pro re nata. 

In purpura and the hemorrhagic diathesis, digitalis is useful when 
given conjointly with restorative medicines ; but, as a dyscrasia exists 
on which the extravasations of blood depend, it is obviously neces- 
sary to correct this state of things, in order that the patient shall 
be benefited by a remedy which gives tone to the heart and vascular 
system. 

The most important uses of digitalis are in cardiac diseases. In 
general terms it may be said that it is indicated when the action of the 



DIGITALIS. 425 

heart is rapid and weak and the arterial tension low, and is contrain- 
dicated when the action of the heart is vigorous and the arterial ten- 
sion high. 

In simple hypertrophy, which is compensatory, digitalis has no 
utility. In stenosis of the aortic orifice, with compensatory hypertro- 
phy, it is not only useless, but it may give rise to serious symptoms, 
and even cause a fatal result, if administered in doses sufficient to 
produce physiological effects (Fernet). When stenosis of the aortic 
orifice leads to incompetence and regurgitation of the mitral, then 
digitalis may be used with advantage. As respects the nature of the 
cardiac lesion merely, digitalis is useful in dilated heart with incom- 
petence of the mitral, in disease of the mitral orifice with stenosis or 
regurgitation, and in dilatation of the right heart with incompetence 
of the tricuspid. As respects the mechanical difficulties which ensue 
from cardiac lesions merely, digitalis is useful, by reason of the in- 
creased power which it gives the auricles and ventricles to empty their 
respective cavities, and the longer intervals between the pulsations, 
which enable the auricles more perfectly to discharge their contents 
into the ventricles. The mechanical difficulty consists in a deficiency 
of blood (ischcemia) on the arterial side, and a stasis of blood on ehe 
venous side, of the systemic and pulmonary circulation. Digitalis, 
therefore, assists in the " compensation," or, in other words, by its ac- 
tion on the heart restores the mechanical balance of the circulation, 
deranged by the cardie lesions. As respects the rational symptoms of 
heart-disease, digitalis is useful when the action of the heart is rapid 
and weak, the tension of the pulse low, when there are cough, diffi- 
culty of breathing, a dusky countenance, pulsating jugulars, scanty 
and high-colored urine, and general dropsy. As a rule, it may be 
stated that the rational signs furnish more conclusive indications of 
the need of digitalis than the physical. If given in suitable cases, the 
action of digitalis in heart-diseases is most conspicuous for good ; but 
careful consideration should be given to the conditions detailed above 
if the practitioner would procure thoroughly satisfactory results. The 
form in which digitalis is prescribed is most important. The infusion 
is the best form in cases of cardiac disease with dropsy. It should 
be given in tablespoonful doses, twice a day, until some characteris- 
tic physiological effects are produced. After the subsidence of the 
severe symptoms, digitaline-granules may be substituted for the infu- 
sion, or the powder of the leaves may be given in pill-form. As very 
decided anaemia is present in these cases, the best results are obtained 
by a combination of digitalis with quinine and iron. I> Pulv. digi- 
talis, 3ij ; ferri redacti, quininae sulph., aa 3j. M. Ft. pil. no. xx. 
Sig. : One pill two or three times a day. 

The antipyretic effect of digitalis is a fact much insisted on in 
Germany (Traube, "Wunderlich, Thomas, Liebermeister, etc.). In the 



426 EXCITO-MOTORS. 

recent elaborate work of Husemann digitalis is classed with the Fie- 
bermittel — the " antipyretica." The results which have followed its 
administration as an antipyretic in fevers (typhoid, typhus, etc.) do 
not, it appears to the author, justify its use in these maladies, notwith- 
standing its power to lower the temperature. Prof. Leyden regards 
it as unsafe as an antipyretic. The indications for its use are, ac- 
cording to Liebermeister, just the opposite of those which obtain in 
cardiac disease ; that is, " digitalis is only to be used in those cases of 
typhoid fever in which there is no considerable degree of cardiac 
weakness." He usually gives from eleven to twenty-two grains, ex- 
tended over a period of about thirty-six hours. 

In scarlet fever the utility of digitalis is very great ; it lowers the 
temperature and maintains the action of the kidneys, thus obviating 
the two principal sources of danger in that disease. Dr. Daniel Lewis, 
of New York, influenced by the author's opinions on this point, system- 
atically used digitalis as the chief remedy in an epidemic of scarlet 
fever in New York, and presented the results in a paper submitted to 
the State Medical Society. While the mortality from this disease, for the 
city at large, is 23 per cent, for Dr. Lewis's cases it was less than 11 
per cent. From a teaspoonf ul to a tablespoonf ul (according to age) of 
the infusion every two, three, or four hours, is a suitable mode of ad- 
ministration. If uraemia occur, the infusion is the proper remedy, con- 
joined, of course, with other means. The author has seen most excel- 
lent results from a poultice of digitalis-leaves, applied to the abdomen 
and back, in cases of urmmic convulsions, the patient being unable to 
swallow, or the stomach so irritable as to reject all medicines. 

Digitalis has been used with success in erysipelas, but it is by no 
means equal to belladonna in this affection. 

In rheumatic fever the testimony in favor of the use of digitalis is 
certainly very strong. It lowers the temperature, and apparently ma- 
terially shortens the duration of the disease. It may be given in 
powders — two grains every four hours — or a corresponding quantity 
of the infusion. In rheumatism, as in every other affection, very 
prompt effects do not follow the use of digitalis ; a day or two must 
elapse before any marked reduction of temperature takes place, but a 
cessation of the joint-trouble may be looked for in seven to ten days. 
Digitalis is more particularly useful in the cardiac compilations of 
acute rheumatism, when irregular and feeble action of the heart, diffi- 
cult breathing, cyanosis, and general oedema, are present. The follow- 
ing is a prescription of Oppolzer in this condition : 3 I n £ digitalis, 
3 i j ; liq. potassii citrat., § jss ; acet. scillse, | ss. M. Sig. : A table- 
spoonful every four hours. 

Digitalis has recently been much employed in inflammatory affec- 
tions, notably pneumonia. On examination of the reported cases the 
author finds that the defervescence, produced apparently by digitalis 



DIGITALIS. 427 

from the sixth to the tenth day, occurred at the time when the crisis 
in pneumonia is to be expected, and hence it is difficult, if not impos- 
sible, to estimate the precise share which the remedy had in the results. 
That digitalis has any power to prevent the deposition of fibrinous 
material, to prevent or check the migration of the white corpuscles, or 
to arrest the multiplication of the cellular elements of inflamed parts, 
seems to the author highly improbable. That it may be useful to com- 
bat some of the symptoms — high temperature, ischaemia of the arterial 
system from pulmonary obstruction, and low tension of the vessels — 
may be well admitted. 

There is considerable evidence to show that digitalis is serviceable 
in chronic bronchitis with interstitial pneumonia (fibroid lung), when 
accompanied with difficult breathing, secondary dilatation of the right 
cavities, and general anasarca. It diminishes the cough and expec- 
toration, tones up the weakened and laboring heart, and reduces the 
oedema. That digitalis has any curative power in pulmonary tubercu- 
losis or caseous pneumonia, can hardly be credited, notwithstanding 
the claims which have been put forward. It may be used as an anti- 
pyretic when there is much hectic, but the derangement of the intes- 
tinal canal produced by it is a most serious bar to its employment in 
phthisis. 

Some important results have been obtained by the use of digitalis 
in nervous diseases. The congestive form of hemicrania may not un- 
frequently be permanently relieved by the persistent use of digitaline- 
granules (one sixtieth of a grain bis die). Acute maniacal delirium, 
chronic mania, and delirium tremens, are disorders of the brain in 
which digitalis has proved very useful. The conclusions of Dr. Will- 
iams, of Hay ward's Heath Asylum, are as follow : 

" 1. That digitalis is a valuable sedative in the treatment alike of 
recent and chronic mania, and when these forms of disease are compli- 
cated with general paresis and with epilepsy. 

" 2. That the average dose of the tincture is from 3 ss to 3 j, and 
this quantity may be certainly given with impunity for several days, 
and subsequently — adjusted to the state of the pulse — may be advan- 
tageously used for several months. 

" 3. That the indication by which the use of this drug is regulated 
is the state of the pulse, any marked intermittence requiring its imme- 
diate discontinuance. 

"4. That the weakness of the circulation is no indication against 
its employment ; on the contrary, experience shows that the most en- 
feebled subjects bear its administration as well as the most robust." 

In delirium tremens extraordinary doses of the tincture of digitalis 
have been used with success ( 3 ij — 3 iv), but these large doses are un- 
necessary. This treatment is most useful in the young and robust, 
with marked cerebral hyperemia, according to some ; but, according to 



428 EXCITO-MOTORS. 

others, in pale subjects with a tendency to cyanosis, the state of the 
brain being one of anaemia, with effusion and oedema. According to 
the author's observation, the latter indications are the more correct. 
The infusion is doubtless a better preparation than the tincture, and 
of this a tablespoonful may be administered every four hours. 

Some supposed cases of arachnitis have been reported cured by 
digitalis, but grave doubts must exist as to the accuracy of the diag- 
nosis. 

Cases of exophthalmic goitre in young subjects, purely functional 
in character, have been cured by digitalis, and the cardiac irregulari- 
ties, and the dilatation of the cervical vessels, ameliorated in even in- 
curable cases. Digitaline is the form in which to employ this remedy, 
or powdered digitalis may be given in pill, with iron and manganese to 
remove the anaemia. 

Since the anaphrodisiac properties of digitalis were ascertained, it 
has been much used in spermatorrhoea. It is adapted to the same class 
of cases as those in which ergot has been shown to be so beneficial, viz., 
feeble erections, frequent emissions, and cold hands and feet. The au- 
thor has seen better results from the combination of bromide of potas- 
sium and digitalis, in the spermatorrhoea of plethora, than from any 
other remedies : ^ Inf. digitalis, § viij ; potassii bromidi, § j. M. 
Sig.: A tablespoonful morning and night, and, after^a week, at night 
only. 

Digitalis is one of the most generally useful remedies in dropsy 
which we possess. It is, of course, specially indicated in the mechanical 
dropsy of valvular lesions. In renal dropsy from acute desquamative 
nephritis (tubal nephritis) " of all drugs, digitalis is of the greatest 
value," and the best form in which to administer it is the infusion. 
Several days usually elapse before very decisive results are achieved, 
but the flow of urine is, then, often enormous. The fact that, contrary 
to what has been heretofore believed, digitalis has a direct action on 
the glomerule of the kidney, is of great interest in this connection. 
The author has seen very favorable results from the use of digitalis 
in granular degeneration of the kidney when dropsy supervened, but 
its use in this disease requires caution in consequence of the fact 
that the elimination of urea and of the chlorides is retarded by this 
agent. 

The so-called Cumulative Effects of Digitalis. — The author agrees 
in opinion with those who hold that digitalis is not a cumulative poison 
in the sense in which this term was formerly used. Doses of digitalis 
frequently repeated, so that the effect of one is added to those before 
given, will certainly produce toxic symptoms. In this sense opium, 
belladonna, strychnine, etc., are cumulative poisons. If full doses of 
digitalis are given at proper intervals, and the effects of one dose are 
permitted to cease before the next is given, no accumulation will take 



CONYALLARIA. 429 

place. Sudden toxic symptoms are developed as follows : When, after 
the administration of large doses, the pulse is much reduced in the re- 
cumbent posture, on rising, the heart is suddenly found unequal to 
maintaining the circulation in face of the increased resistance in the 
arterioles and against the force of gravity. It must not be forgotten, 
further, that the irritability of the vaso-motor nervous system may be 
destroyed by over-stimulation by digitalis, and lethal effects be pro- 
duced in this way. 

Authorities referred to : 

Ackermann, Prof. Th. Ueber die Wirkungen der Digitalis. Volkmanrts Sammlung, 
No. 48. 

Boehm, Dr. Rudolph. Ueber die physiologische Wirkung der Digitalis und des Digi- 
talin. Schmidt's Jahrbucher, vol. cliii, 18*72. 

Briesemann, Dr. C. Schmidt's Jahrbucher, vol. cliii, p. 29. 

Dybkowsky, W., fnd Pelikatt, Eug. Schmidt's Jahrbucher, vol. cxvi, p. 170. 

Foster, Dr. B. Clinical Medicine: Lectures and Essays, 1874, p. 92. Digitalis in 
Heart Disease. 

Fothergill, Dr. J. Milner. Prize Essay. British Medical Journal, July and August, 
1871. 

GorRVAT, M. Gazette de Paris, July to December, 1871, and January to February, 
1872. 

Hirtz, Dr. Gazette Medicate de Strasbourg, 1862. 

Holland, Sir Henry. Medical Notes and Reflections, American edition. 

Homolle, M. Archives Generates, July, 1861, p. 5. 

Husemann, Prof. Dr. Th. Handbuch der gesammten Arzneimittellehre, zweiter Band, 
p. 914, et seq. 

Kohler, Dr. H. Ueber den Antagonismus der physiologischen Wirkungen der Saponin 
und Digitalin. Archiv f. exper. Path, und Phar., 1873, p. 138. 

Liebermeister, Prof. Dr. Karl. Ziemssen's Cyclopaedia of the Practice of Medicine, 
vol. i,p. 217. 

Leyden, Prof. Dr. Deutsche med. Zeitschrift, No. 23, 1881. 

Maudsley, Dr. Henry. The Practitioner, January, 1869. 

Schmiedeberg, Prof. Archiv fur exper. Pathol, und Pharmacol, Band iii, p. 16. 

Taylor, Dr. A. S. On Poisons, third edition, London, p. 796. 

Traube, Prof. Dr. L. Berliner klinische Wochenschrift, No. 17, April, 1870, and No. 
18, May 2, 1870. 

Weil, Dr. A. Schmidt's Jahrbucher, vol. cliv, p. 143. 

Convallaria. — All parts of the plant of Convallaria majalis (lily- 
of-the-valley). (Not official.) 

The Preparations. — It is a remarkable fact that different proper- 
ties are possessed by extracts made from the various parts of the plant. 
An extract made from the root has very powerful emeto-cathartic 
property, while it but little affects the action of the heart. The same 
fact is true, to a less or greater extent, of extracts from the whole 
plant. This emeto-cathartic action is due to the presence of a rather 
acrid resin, and hence for the purpose now intended to be subserved 
by the administration of convallaria the preparation used must be 
freed from this resin. An extract prepared from the flowers and 



430 EXCITO-MOTORS. 

stalks, mixed with a third of their weight of leaves and root, is, ac- 
cording to Langlebert, the best preparation, when deprived of the 
resin. In this shape it is a solid extract, has a shining black color 
and a bitter taste, and is freely soluble in water and alcohol. 

Extractum Convallarice. — Extract of convallaria. Dose, gr. v — 
gr. xv. 

An infusion of the flowers, leaves, and stems is also used. Troitz- 
ky employed several formulas in his trials — from two to four scruples 
of convallaria to four ounces of water. 

Infusum Convallarioe. — Infusion of convallaria (convallaria, 50 
parts ; water, 200 parts). Dose, a tablespoonful. Another formula 
is eight ounces of convallaria to a pint of boiling water, which is twice 
the strength of the above. 

As the active principle presents many advantages, this will proba- 
bly be preferred for administration in cardiac affections. 

Composition. — In 1858 Walz announced the presence in this plant 
of two glucosides — convallarin and convallamarin. There are impor- 
tant differences in the qualities of these substances. The former, con- 
vallarin, occurs in colorless, rectangular prisms, is slightly soluble in 
water, but freely so in alcohol. Convallarin, as Marme first ascertained, 
is a purgative in doses of three or four grains (Husemann). It is 
probable that the presence of this glucoside in the resin is the secret 
of the cathartic property of this substance, in part at least. Conval- 
lamarin is not cry stalliz able, is a white powder, bitter, and freely sol- 
uble in water and alcohol, but not in ether. The dose when admin- 
istered by the stomach will range from one fourth of a grain to two 
grains ; but further investigations are needed to decide this point. 
This is the principle of convallaria, to which its cardiac actions are 
due. It is probable that the perfectly pure alkaloid possesses much 
greater activity than the dose above stated indicates. 

Physiological Actions. — For some time no other powers were 
attributed to convallaria than those of a cathartic intermediate in 
action between scammony and aloes. In Russia it has long been 
known as a remedy for dropsy. This fact finally induced Troitzky 
and Bojojawlensky to study its action more closely, and Prof. Bot- 
kin, of St. Petersburg, subsequently confirmed their researches. 

It was not, however, until Prof. See undertook the study of its 
powers and actions, that general interest was aroused, although Marme 
had, as is stated above, some time before, given an accurate account 
of the physiological actions of convallaria. Since the publication of 
See's observations, the actions of this medicament have been inves- 
tigated by various English and American observers. From these 
sources, and some personal studies, the author makes up the follow- 
ing account : 

Notwithstanding the emeto-cathartic action, if the extract freed 



CONVALLARIA. 431 

from the resin, or convallamarin, the active principle, is given, no dis- 
turbance of the stomach occurs. It stimulates the appetite somewhat, 
and digestion is not impaired. An increase of peristalsis occurs, and 
the evacuations, without being loose, become easy. In warm-blooded 
animals it slows the heart and raises the arterial tension. At the 
same time the respiratory movements are rendered more full and 
somewhat less frequent. These effects are due to stimulation of the 
vagus, but the nerve does not lose its irritability. If the dose be lethal, 
after this first stage, the heart becomes irregular in rhythm, the force 
of the cardiac contractions varies, and the respirations are disturbed, 
inspiration growing deep and prolonged, owing to spasm of the inspir- 
atory group of muscles (See). In the third period of the action, just 
before death, the arterial tension rises very high, but the pulse is ex- 
ceedingly rapid ; then the pressure falls, the respiration growing 
deeper and very slow, and the heart stops in systole, before the breath- 
ing finally ceases. The vagus does not wholly lose its irritability, but 
near the end a strong faradic current does not stop the heart. The 
irritability of the motor and sensory nerves remains unaffected, and 
the muscles preserve their contractility. The pupil is unaffected and 
the functions of the brain are undisturbed. 

The diuretic effect of convallaria is very constant and decided, a 
fact long known in Russia, but no change occurs in the composition 
of the urine. 

Therapy. — In suitable doses — 15 to 25 grains of the extract — con- 
vallaria slows the heart-beats, and often restores the normal rhythm 
of the heart when disturbed, increases the energy of the cardiac con- 
tractions, raises the arterial tension, and at the same time the respira- 
tory movements acquire increased force and volume. These impor- 
tant therapeutical effects are wrought without affecting the functions 
of the brain and spinal cord. It is also a prompt and certain diuretic, 
increasing the discharge of all the urinary constituents. The therapeu- 
tical indications based on these physiological actions are the follow- 
ing : Palpitation, disordered rhythm, or vehement action, dependent on 
impaired function of the pneumogastric, or on hypertrophy of the mus- 
cular walls ; narrowing of the mitral orifice (mitral stenosis) or insuf- 
ficiency of the mitral valves, with stasis in the venous circulation, with 
or without spasmodic breathing ; dilated heart, with or without fatty 
change or sclerosis ; in all cardiac affections accompanied by dropsy 
(See). The signal advantage which it offers over digitalis is the 
absence of danger from its administration, and the freedom of the 
cerebro-spinal axis and the digestive organs from disturbance. It 
has now been used in the maladies above mentioned by numerous 
observers in various parts of the world ; and, although the reports are 
not uniformly favorable, there can be no doubt that we have in con- 
vallaria an important addition to our resources. 



432 EXCITO-MOTORS. 

Authorities referred to : 

Ferrand, Dr. G. Sur le Muguet [convallaria]. Annuaire de Therapeutique, Bouchar- 
dat, 1883, p. 135. 

Juk, Dr. London Medical Record, June 15, 1883. 

Langlebert, M. Adolphe. Note sur le Convallaria Ma'ialis. Bull. Gen. de Therap., 
vol. ciii, p. 74. 

Moutard-Martin, Dr. Sur la valeur de Vextrait de Muguet comme medicament diu- 
retique. Bouchardaf s Annuaire for 1883, p. 132. 

See, Prof. Germain. Rccherches ezperimentales sur le Muguet (Convallaria Ma'ialis). 
Bull. Gen. de Therapeutique, vol. ciii, p. 49. 

Tanret, C. Ibid., vol. cii. Convallamarine, principe actif du Muguet (Convallaria 
Ma'ialis). 

Troitzkt and Bojojawlensky. Wratch 47 and 49. Annuaire de Therapeutique, 
1883, p. 127. 

Cimicifuga. — Black snake-root. The rhizoma and rootlets of Cimi- 
cifuga racemosa Elliott (Nat. Ord. Manunculacem). (U. S. P.) 

JExtractum Cimicifugce Fluidum. — Fluid extract of cimicifuga. 
Dose, 3 ss — 3 ij. 

Tinctura Cimicifugce. — Tincture of cimicifuga. Dose, 3 ss — 3 ij. 

Composition. — When fresh, the root contains a volatile oil, which 
possesses in a high degree the characteristic odor of the drug. A true 
active principle has not yet been isolated, yet Conard has obtained a 
neutral substance, crystallizable, and having a very acrid taste. The 
so-called cimicifugin is nothing more than an impure resin, obtained 
by precipitation from the tincture by the addition of water. The root 
contains resin, coloring matters, tannic and gallic acids. 

Antagonists and Incompatibles. — As the preparations of cimici- 
fuga contain tannic and gallic acids, they are incompatible with the 
salts of iron. Stimulants, as alcohol, ammonia, antagonize cimicifuga 
therapeutically. 

Synergists. — In its action, although feeble, cimicifuga lies between 
digitalis and ergot. Its physiological effects are increased by cold, 
digitalis, ergot, belladonna, etc. 

Physiological Actions. — The taste of cimicifuga is bitter and 
astringent, with an after acrid feeling. In small doses, without pro- 
ducing any sensible physiological effect, it promotes the appetite and 
digestion. In full doses it increases the gastro-intestinal secretions. 
On the heart and circulatory system, cimicifuga has an action not un- 
like digitalis, but less powerful : it slows the heart-beats but increases 
their force, and elevates the tension of the arterial system. Its effects 
on the nervous system, when administered in large doses, are very de- 
cided. It causes vertigo, dilated pupils, and in many subjects consid- 
erable soporific and anodyne effects. There is little doubt that it 
increases the contractility of unstriped muscular fiber in a manner 
that resembles ergot, but much less energetically. It stimulates the 
venereal appetite in man, and promotes the menstrual flow in women. 



CIMICIFUGA. 433 

Diaphoresis and increased bronchial secretion are produced by it, and 
the urine possesses a distinct odor of the drug. 

In order to procure physiological effects from cimicifuga, it is essen- 
tial that preparations made from the fresh root be employed. 

Therapy. — Cimicif uga is an excellent stomachic tonic, and is espe- 
cially adapted to the treatment of the irritative dyspepsia of drunk- 
ards. In fevers and inflammatory disorders, when the action of the 
heart is quick and the tension of the vessels low, cimicif uga may take 
the place of digitalis, but it is much less efficient than the latter. It is 
an excellent expectorant, useful in bronchitis and in neuropathic pulmo- 
nary disorders. 1} Ext. cimicif ugse n., § ss ; tinct. opii deod., 3j ; 
syrup, tolu., 3 xj. M. Sig. : A teaspoonful every four hours. This 
combination is efficacious in acute catarrh (common cold), and in acute 
bronchitis after the more active symptoms have subsided. Good results 
have been obtained from cimicif uga in phthisis. It would be idle to 
claim that it is curative ; but, to moderate hectic, to improve the appe- 
tite, and to facilitate expectoration, it is undeniably of service. It is 
in that form of phthisis now called caseous pneumonia that cimicif uga 
can be expected to relieve symptoms, and not in tuberculosis. 

Dilated heart, fatty heart, languid circulation, oppressed breathing, 
general dropsy, are conditions in which cimicifuga takes the role of 
digitalis, and although less efficient, it is safer, especially in the case 
of fatty heart. 

Most favorable reports have been made of cimicifuga in acute rheu- 
matism. Chronic rheumatism, with tumefaction of the joints, lum- 
bago, intercostal pain, and myalgia, are disorders affecting the mus- 
cular system, in which this drug sometimes succeeds in a wonderful 
manner ; yet it very often fails, and we are, unfortunately, unable to 
indicate beforehand the particular kind of cases in which it is most 
beneficial. 

The power of cimicifuga to relieve certain kinds of pain is well 
established. Neuralgia of the fifth, arising from cold, rheumatic head- 
ache, ovarian neuralgia, succeeding to suppressed or arrested menstru- 
ation, etc., are forms of pain in which this remedy is frequently very 
effective. 

Puerperal mania, hypochondriasis, and convulsions, due to men- 
strual irregularities, have been cured by cimicifuga. The greatest 
successes of this drug have been achieved in chorea. It is useful in 
those cases which arise about the period of puberty, and are connected 
with disorders or perversions of the menstrual flow. 

Cimicifuga relieves the pains of dysmenorrhoza when of the con- 
gestive variety. Heat of head, flushings of the face, pain in the head, 
back, and limbs, quick pulse, and nervousness, when due to arrest of 
the monthly flow, are often remarkably benefited by this agent. It has 
been used to promote parturient pains, to induce uterine contractions 

28 



434 EXCITO-MOTORS. 

after delivery, and to relieve after-pains, but it is inferior to ergot for 
most of these purposes. It is serviceable in subinvolution of the uterus, 
and may be given in combination with ergot. 

The aphrodisiac effects of cimicifuga render it useful in sperma- 
torrhoea. It is not adapted to physiological spermatorrhoea, which is 
really a condition of normal plethora, but to those cases in which the 
organs are relaxed, the erections weak, and the seminal discharges 
feeble and occur on slight excitement. 

To obtain curative effects from cimicifuga, it must be administered 
in sufficiently large doses to produce some of its cerebral effects. 

Authorities referred to : 

Davis, Dr. N. S. Transactions of the American Medical Association, i, 352. 
Hildreth, Dr. American Journal of Medical Sciences, October, 1842. 
Phillips, Dr. Charles D. F. Materia Medica and Therapeutics, London, 1874, 
p. 39. 

Porcher, Dr. Francis P. Resources of the Southern Fields and Forests, p. 18. 
Ringer, Dr. Sydney. Handbook of Therapeutics, article Aetata. 
Stille, Dr. Alfred. Therapeutics and Materia Medica, vol. ii, p. 562. 

Belladonna. — Deadly nightshade. 

Belladonna} Folia}. — Belladonna - leaves. The leaves of Atropa 
belladonna Linne (Nat. Ord. Solanacew), U. S. P. Feuilles de bella- 
done, Fr.; Tollkraut, Ger. 

Belladonnm Radix.— Belladonna-root. The root of Atropa bella- 
donna, as above. Racine de belladone, Fr. ; Belladonnawurzel, Ger. 

Abstractum Belladonna?. — Abstract of belladonna. Dose, gr. ss— - 
gr. j. Prepared from the root. 

Emplastrum Belladonna}. — Belladonna-plaster. (Belladonna-root 
and resin-plaster.) 

Mctractum Belladonna}. — Extract of belladonna. Dose, gr. i— gr. j. 

Extr actum Belladonna} Alcoholicum. — Alcoholic extract of bella- 
donna. Dose, gr. \ — gr. j. Prepared from the leaves. 

Extractum Belladonna} Fluidum. — Fluid extract of belladonna. 
Dose, ttl j — Til v. Prepared from the root. 

Tinctura Belladonna?. — Tincture of belladonna. Prepared from 
the leaves. Dose, ttj, v — 3 ss. 

Composition. — Belladonna contains a peculiar alkaloid, atropine, 
on the presence of which the physiological activity of the drug de- 
pends. This principle is found chiefly in the bark of the root, and of 
young root. Another principle has also been discovered analogous to 
atropine, to which the name belladonnine has been given. Ladenburg 
has shown that belladonnine is identical with the active principle of 
hyoscyamus, or hyoscyamine. It is identical with atropine in compo- 
sition, and can only differ in the arrangement of its molecules. The 
root also contains a fluorescent substance and a coloring matter, which 



BELLADONNA. 435 

has been called atrosin. Atropine exists in the plant in combination 
with malic acid as Mmalate. 

Atropina. — Atropine. Is in yellowish-white, silky, prismatic crys- 
tals, without smell, but having a bitter and acrid taste. It is soluble 
in three hundred parts of water at 60° Fahr., in twenty-five parts of 
ether, and in much less alcohol. It has a strong alkaline reaction, 
and forms cry stall izable salts with acids. 

Atropine® Sulphas. — Sulphate of atropine. Is a white, slightly 
crystalline powder, very soluble in water and in alcohol, insoluble in 
ether, and wholly dissipated by heat. Dose, gr. yj-g- — gr. ■£$. 

Antagonists and Incompatibles. — Caustic alkalies act on atro- 
pine, and ammonia is evolved ; they are, therefore, incompatible with 
the preparations of belladonna. As respects physiological antagonism, 
physostigma and pilocarpus counterbalance the actions of belladonna 
in almost the whole range of its influence. Opium — within certain 
limitations to be hereinafter described — antagonizes the actions of 
belladonna. In cases of poisoning, the stomach should be promptly 
emptied by emetics (sulphates of zinc or copper), and the nervous 
disturbances combated, as they arise, by physostigma, opium, or pilo- 
carpus. 

Physiological Actions. — Dryness of the mucous membrane of 
the nose, mouth, throat, and larynx, is produced by the direct applica- 
tion of atropine to these parts, and the same effects in a more positive 
manner follow the stomach or subcutaneous administration. A peculiar 
bluish appearance of the lips, as well as dryness, the author has fre- 
quently observed. Nausea is occasionally produced by belladonna, 
but this effect is probably due to cerebral disturbance. Dryness of the 
mucous membrane of the stomach and intestines is doubtless produced 
by belladonna, but increased secretion occurs subsequently, for the 
stools are rendered more liquid, and are also voided more frequently. 
Increased peristalsis is most probably a result of the action of bella- 
donna on the unstriped muscular fiber of the intestines. 

The active principle of belladonna (atropine) is an extremely diffus- 
ible substance. What changes it induces in the blood, if any, are not 
known. It affects the circulation in a remarkable manner. In some 
subjects a decided slowing of the heart takes place immediately after 
the administration of a considerable dose (atropine hypodermatically), 
and in all, most probably, an instantaneous retardation of the pulse- 
rate, but a very decided rise in the number of pulsations quickly fol- 
lows. Not only is the number of the heart-beats increased, but their 
vigor also, and the area over which the pulsations are distributed is 
enlarged. It has been conclusively shown that the increased action 
of the heart is due, first, to stimulation of the cardiac ganglia of the 
sympathetic, and, secondly, to a paralyzing action on the pneumogas- 



436 EXCITO-MOTORS. 

trie terminal filaments. In other words, the motor power of the heart 
is increased in activity, and the inhibiting control is lessened. 

The stimulation of the vaso-motor centers by belladonna, or atro- 
pine, is not confined to the cardiac ganglia, but extends to the vaso- 
motor ganglia throughout the body, and a general rise of blood-pressure 
takes place owing to a contraction of the arterioles. It is a singular 
fact that the influence of atropine rapidly produces a state of over- 
excitation, and the irritability of the vaso-motor nervous system, at 
first increased, soon diminishes ; the action of the heart becomes weak, 
the vessels dilate, and the blood-pressure falls below the normal. In 
large medicinal doses this effect is easily seen, and, in lethal doses in 
animals, it may be most certainly demonstrated. 

As regards the function of respiration, atropine increases the num- 
ber and depth of the respiratory movements, but the increase is not in 
the same ratio as is the elevation of the pulse-beat. The more rapid 
action of the heart, the increased respiratory movements, the contrac- 
tion of the arterioles, result in an increased supply of blood to the 
periphery, more rapid nutritive changes, and consequent elevation of 
temperature. The rise in temperature in man, from a full medicinal 
dose, is from \° to 1° Fahr. This increased body-heat is not long 
maintained ; with the fall in the blood-pressure (vaso-motor paresis), 
there ensues a diminution in temperature. 

In persons of a light complexion, more especially in women, a full 
dose of atropine is frequently followed by a diffused redness of the 
skin, not unlike the rash of scarlatina, but wanting in the punctated 
character of this specific eruption. Redness of the fauces, and some 
difficulty of swallowing, owing to the dryness of the mucous mem- 
brane, occur at the same time, rendering the similitude to scarlet fever 
very striking. The flush of atropine succeeds to a marked but tem- 
porary pallor, which is the first effect, and is a symptom of the vaso- 
motor paresis which succeeds to the vaso-motor stimulation. The bel- 
ladonna rash is sometimes followed by desquamation. 

Dilatation of the pupil is a conspicuous effect of atropine. Whether 
dropped into the eye, introduced into the stomach, or injected under the 
skin, prompt and decided dilatation of the pupil follows. A much 
smaller quantity suffices to produce this effect, when applied directly 
to the eye. Paresis of the muscle of accommodation is caused by 
atropine, and this agent also lessens the intraocular pressure. It has 
been conclusively shown that atropine produces these remarkable 
effects by an action on the peripheral filaments of the nerves of the 
iris, and net on its muscular fibers ; atropine paralyzes the oculo-motor 
nerve end-organs, and stimulates those of the sympathetic. 

The cerebral effects of belladonna are very characteristic. Head- 
ache, vertigo, illusions, hallucinations, a busy delirium, sometimes 
somnolence, are produced by large doses. The vision is usually lost, 



BELLADONNA. 437 

the pupils are dilated to the utmost, the eyes are brilliant and staring. 
Muscular weakness, inco-ordination, and complete motor paralysis oc- 
cur ; but sensation is not destroyed ; although occupied with fancies 
aud illusions, the patient may be indifferent to moderate irritation. 
The delirium which occurs has a peculiar character : it may be gay 
and laughing, or busy, the patient being incessantly occupied with a 
single object or idea ; or it may be noisy and furious, the patient fight- 
ing and striking all who approach. In lethal doses convulsions may 
occur, or profound stupor may result after a period of delirious excite- 
ment. 

The voluntary muscles are not affected by belladonna. The mus- 
cular paresis which results from the administration of this drug is due 
to its action on the motor nerves, but the excitability of these nerves 
is diminished only, and not wholly destroyed. Both the motor-nerve 
trunks and the end-organs are affected. The sensibility of the sensory 
nerves is also impaired, but is not diminished to the same extent as is 
that of the motor nerves. 

Although the action of belladonna is so largely paralyzant, it is 
not exclusively so, and, under certain circumstances, a tetanic action 
very similar to that caused by strychnine is developed. In frogs, a 
day or two after the induction of paralysis by the subcutaneous injec- 
tion of atropine, the tetanic state occurs. When this state is reached, 
although the frog lies perfectly limp and motionless if undisturbed, an 
irritation applied to the periphery will at once cause general tetanic 
rigidity and spasms. The author was the first to show that this con- 
dition of the nervous system is attained in frogs an hour or two after 
the conjoined administration of atropine and physostigma (eserine). 

Atropine, by virtue of the greater than normal transmission of 
blood through the tissues, increases metamorphosis, and the results of 
this are represented in an increased elimination of the products of waste. 

Atropine is eliminated chiefly by the urine, and the urine of an 
atropinized animal will dilate the pupil of another animal. 

Therapy. — In mercurial ptyalism, and the ptyalism of the preg- 
nant state, a few drops (five to ten) of the tincture of belladonna, 
given every four to six hours, or a corresponding quantity of atropine, 
will cause the excessive secretion to diminish, and even dry up, and 
will thus relieve a very disagreeable symptom. Gastralgia, as well as 
the pain which accompanies gastric ulcer, is often happily relieved by 
atropine. I), Atropine sulphatis, gr. j ; zinci sulphatis, 3 ss ; aquse 
destil., I j. M. Sig. : From three to five drops twice or thrice a day. 
A similar combination is very effective in pyrosis, chronic gastric ca- 
tarrh, and irritative dyspepsia. Atropine is frequently effective in 
relieving the vomiting of pregnancy. ty Atropinae sulphat., gr. ij ; 
aquas destil., J j. M. Sig. : Tico drops in water before meeds. It is 
often more useful when applied to the rectum in the form of supposi- 



438 EXCITO-MOTORS. 

tory. It sometimes gives great relief when applied to the epigastrium 
in chloroformic solution. t> Atropinse, gr. v ; ehloroformi, § j. M. 
Sig. : A piece of lint to be moistened with the solution and laid on the 
epigastrium. 

The extract of belladonna is a useful addition to purgatives, to di- 
minish the harshness and at the same time to increase the effectiveness 
of their operation. Belladonna has the power to increase the peristal- 
tic movements and to allay irregular or spasmodic movements. It is, 
therefore, used to overcome habitual constipation. A pill containing 
a half -grain of extract, taken at night, will sometimes succeed, but it 
is generally better to combine it as follows : t> Ext. belladonnae, ext. 
nucis vomicae, ext. physostigmatis, aa gr. iij. M. Ft. pil. no. vj. Sig. : 
One at bed-hour. An addition of a half -grain of aloine will, of course, 
increase the action of this pill, and may be added when there are great 
torpor and inaction of the intestines. 

When, in affections of the gastro-intestinal apparatus, acids are in. 
dicated with atropine, they may be combined as follows : I£ Acid, 
muriat. dil., § j ; atropine, gr. ss. M. Sig. : Five drops in water 
before meals. Such a prescription is useful in heart-bum, water- 
brash, etc. 

Harley advises the use of atropine as a cardiac stimulant ; but the 
fact that this agent exhausts the irritability of the cardiac ganglia 
after a period of excitement requires discrimination in its use. Not- 
withstanding this objection, atropine may be given to counteract a 
sudden and temporary depression in the heart's action — as, for exam- 
ple, in the collapse of cholera, in which it has been employed success- 
fully by the hypodermatic method. 

Belladonna is a remedy of great efficacy in certain acute inflamma- 
tions of the air-passages. No remedy gives such prompt and sustained 
relief in acute nasal catarrh with profuse watery secretion. To adults, 
the best method of administration consists in giving a first dose of five 
drops of the tincture, and repeating a drop or two drops every hour 
until atropinism is produced. This remedy is also very admirably 
adapted to the treatment of ordinary sore-throat. As a constant phys- 
iological action of belladonna is redness and dryness of the fauces, its 
therapeutical action, in sore-throat with increased secretion, is anti- 
pathic or substitutive ; or, as it may be more scientifically expressed, 
the action of belladonna is the physiological antagonist of the disease- 
action. When there is much fever it is useful to combine aconite with 
belladonna. 5- Tinct. aconiti rad., 3 j ; tinct. belladonna, 3 ij. M. 
Sig. : Four drops in water every hour or tico. That form of aphonia 
which is due to fatigue of the vocal cords may be removed very speed- 
ily by a morning and evening dose ( T J ¥ — ^ of a grain) of atropine. 
Not unfrequently hysterical aphonia may be quickly cured in the 
same way. 



BELLADONNA. 439 

There is much to be expected from the use of belladonna prepara- 
tions in whooping-cough. The best form for administration is a solu- 
tion of the sulphate of atropine (gr. j — § j of water. Dose, tij, ij — 
tti iv). This remedy is not adapted to all cases, and is most effective in 
the spasmodic stage. In order to be curative, physiological effects 
must be produced. The good results of atropine in whooping-cough 
are most obvious in those cases characterized by profuse bronchial 
secretion. 

Belladonna gives great relief in paroxysms of asthma, and in the 
spasmodic difficulty of breathing which accompanies emphysema. Ac- 
cording to the author's observation, when the bronchial mucous mem- 
brane is deficient in secretion, the pulse much accelerated, the skin dry 
and hot, belladonna rather adds to the distress ; and its good effects 
are most conspicuous when there are abundant expectoration, a cool 
and moist skin, and a quiet pulse of low tension. In asthma, atropine 
may be injected subcutaneously, or the belladonna-leaves be used by 
the method of fumigation. Belladonna-leaves, dipped in a saturated 
solution of niter and then dried, may be burned in a close apartment, 
the patient breathing the fumes until relief is obtained. Pastiles are 
made of belladonna, stramonium, poppy, tobacco, etc. A good for- 
mula for cigarettes is the following (Trousseau) : Belladonna, grs. v ; 
stramonium and hyoscyamus, of each grs. iij ; extract of opium, \ of 
a grain ; cherry-laurel water, a sufficient quantity. The leaves are 
moistened with a solution of the opium in the cherry-laurel water, and 
when dry made into a cigarette. Two to four of such cigarettes may 
be smoked daily. When the paroxysms of asthma occur in the morn- 
ing, they may sometimes be prevented by the one sixtieth of a grain 
of atropine at bedtime. 

The remarkable similarity in the symptoms of atropinism and of 
scarlatina has led to the use, by homoeopathic practitioners, of bella- 
donna as a prophylactic against this disease. The points of resem- 
blance are so superficial, and the differences so wide, that no more 
striking instance could be adduced of the uncertainty in the applica- 
tion of the homoeopathic dogma, even admitting its truth. The au- 
thor is convinced that the so-called prophylactic power of belladonna 
against scarlatina has no real existence. He has seen too many cases 
of scarlatina occur in subjects who had been given the remedy freely, 
to permit him to come to any other conclusion. Belladonna is a use- 
ful remedy to relieve some of the symptoms in scarlatina. During 
the stage of eruption it is indicated when the pulse is feeble, the bod- 
ily powers are depressed, and the rash is imperfectly evolved. In this 
condition of things — in which carbonate of ammonia is so much used — 
belladonna also renders most important service ; but it should not be 
forgotten that these agents are chemically incompatible, and should 
not, therefore, be prescribed together. 



440 EXCITO-MOTORS. 

In diphtheria, when there is much depression, belladonna is a most 
excellent remedy. If given before the exudation has spread and con- 
solidated into membranous plaques, and when a few patches only have 
appeared on the tonsils, or soft-palate, it seems to have the power to 
hinder the formation of the exudation. 

There is no doubt that belladonna has a real curative power in 
erysipelas. It is especially adapted to idiopathic erysipelas, notably 
to facial erysipelas, and is less serviceable in traumatic erysipelas. 
Homceopathists explain this on the doctrine of similars, but the action 
is really one of antagonism, or substitution. When there is much 
fever, digitalis or aconite may be combined with belladonna with ad- 
vantage, and when there is much depression, quinine. I£ Quininae 
sulph., 3 ss ; belladonnas extract., grs. iij . M. Ft. pil. no. x. Sig. : 
One every four or six hours. 

Excellent results have been obtained from the use of belladonna in 
typhus and typhoid fevers. Graves originally suggested an indication 
for its use in fevers, which is doubtless serviceable, viz., contracted 
pupils ; but belladonna has been used, irrespective of this sign, by 
other practitioners with great success. The tincture is a suitable 
preparation, and of this from five to ten drops every four hours is a 
proper dose. According to the author's observation, belladonna is in- 
dicated when there is much low, muttering delirium, subsultus, and 
stupor, and is contraindicated in the condition of delirium ferox. 

Belladonna has important application in the treatment of certain 
disorders of the nervous system. Sick-headache, due to or accom- 
panied by spasm of the arterioles — a condition manifested by pallor 
of the face, vertigo, and tinnitus aurium — is relieved by belladonna. 
At first the distress may be even increased, but great relief presently 
follows. This remedy is injurious in the congestive form of sick- 
headache. The following is a serviceable combination in the cases of 
sick-headache due to vaso-motor spasm : ^ Atropinse sulph., gr. ss ; 
chinoidin, 3 j. M. Ft. pil. no. lx. Sig. : One pill tvnce or thrice a 
day. 

Although belladonna in the physiological state induces wakeful- 
ness and busy delirium, in certain morbid states of the brain it is hyp- 
notic. The indications for its use are as follows : prostration, low 
state of the arterial tension, languid intra-cranial circulation, a con- 
tracted pupil, and insomnia, due to the condition of the brain mani- 
fested by these objective signs. In various kinds of mental disorder, 
in which the foregoing symptoms are present, much good may be ex- 
pected from the use of belladonna in moderate doses ; but harm only 
will be produced by it when there is much vascular excitement. 

Belladonna, according to Trousseau and Pidoux, is a more efficient 
remedy in the treatment of epilepsy than the salts of silver, copper, or 
zinc. They insist that the capital condition of success is perseverance 



BELLADONNA. 441 

on the part of the physician and patient, that belladonna should be 
given steadily for a year in gradually-increasing doses, and that if 
amendment is then produced it should be continued through two, 
three, or even four years. Belladonna is not equal to bromide of 
potassium in cases of diurnal epilepsy, in epilepsy accompanied by 
cerebral hyperemia, and in epileptiform convulsions due to coarse or- 
ganic lesion of the brain. The best results are obtained from it in 
nocturnal epilepsy, in petit mal, and in pale, delicate, and anaemic sub- 
jects, with cold hands and feet, blue skin, and weak heart. 

In neuralgia belladonna affords relief, although not equal to some 
other agents. Given hypodermatically {see p>ost), it is often very effec- 
tive. In any case, its use must be persisted in ; full doses are neces- 
sary, and physiological effects must be produced and maintained for 
some time. A solution of atropine is the best form for the stomach 
administration. Dysmenorrhea, when neuralgic in character, and 
ovarian neuralgia, may be permanently removed by belladonna. It 
is useful in these cases to combine it with synergistic remedies. !£ 
Ext. belladonnas, grs. iv ; ext. stramonii, grs. v ; ext. hyoscyami, grs. 
v; quininae sulphat., 3ij. M. Ft.pil.no. xx. Sig. : One pill tic o or 
three times a day. When anaemia exists, iron may be added to this 
formula. 

No single agent has been as uniformly successful in the treatment 
of nocturnal incontinence of urine as belladonna. This morbid state 
is due to several conditions, and belladonna is not equally successful 
in all : nocturnal incontinence may be due to an excess in the acidity 
of the urine, which renders it unduly stimulating ; to relaxation of 
the sphincter vesicae ; to an irritability of the mucous membrane, in 
consequence of which erroneous impressions are communicated to the 
brain. Belladonna gives relief in the two last-named conditions. The 
atropine dissolved in the urine acts locally on the nerves of the mucous 
membrane, diminishing their irritability ; the sphincter is put into a 
state of tonic contraction by reason of the systemic effect, which 
includes, of course, the sympathetic system. The error is often com- 
mitted of giving too little of the remedy ; systemic effects must be 
produced, and children, compared with adults, are insusceptible to 
the action of belladonna. The best form for administration, be- 
cause less disagreeable and more constant in effect, is a solution of 
atropine. 

Nocturnal seminal losses, as respects mechanism of production, 
making allowance, of course, for difference of seat, have a strong 
analogy with nocturnal incontinence of urine. This trouble may be 
considered a morbid state, only, when the losses are frequent and affect 
the health. Bromide of potassium best relieves spermatorrhoea, so 
called, when it is largely physiological and due to a normal plethora ; 
belladonna is most serviceable when the genitalia are relaxed, the 



442 EXCITO-MOTORS. 

emissions flowing without force, and without a distinct dream and 
orgasm. 

Atropine is a remedy of the greatest importance in the practice of 
ophthalmology. As it dilates the pupil, diminishes the intraocular 
pressure, contracts the arterioles, and acts topically on the sentient 
nerves, it is obvious that its field of utility is wide, and its therapeutic 
power great. 

In phlyctenular keratitis atropine renders the greatest service ; it 
diminishes the photophobia and blepharospasm, and lessens the blood- 
supply by contracting the vessels. It has a still more beneficial action 
in iritis ; it prevents adhesions, anterior and posterior, and by dilata- 
tion of the pupil so compresses the vessels as to jugulate the inflam- 
matory process. When the cornea is perforated, herniary protrusion 
and adhesion of the iris are prevented by dilating the pupil. For these 
purposes a four-grain solution of atropine is the proper strength for in- 
stillation into the eye. When it is desirable to suspend the power of 
accommodation, in cases of hypermetropia to determine the refraction 
of the eye, and in astigmatism to ascertain the difference in the me- 
ridians, atropine is used. A weak solution only is employed, to dilate 
the pupil for a brief period, in order to facilitate the examination of 
the fundus of the eye. Dilatation of the pupil with atropine is also 
necessary in the examination of cataract, especially in the early stages 
of its formation. It should be remembered that strong solutions of 
atropine instilled into the eyes may, by subsequent absorption, pro- 
duce atropinism, and to such an extent as to occasion solicitude. 

In certain affections of the shin belladonna is useful — viz., in the 
cutaneous neuroses, prurigo, herpes zoster, erythema, and eczema, etc. 
Cases of these affections which resist ordinary treatment, yield to bella- 
donna. The tincture, or the alkaloid, in suitable doses, may be given 
in quantity sufficient to maintain a slight physiological action. Hyper- 
idrosis (colliquative sweating), unilateral sweating, and other forms 
of profuse transpiration through the skin, are arrested by the internal 
and, in some cases, by the local application of the belladonna prepara- 
tions, as Ringer has shown. 

No remedy is so generally effective in relieving the sweats of 
p>hthisis as atropine. The one sixtieth of a grain at bedtime usually 
suffices. The author was the first to indicate this use of atropine in his 
"Prize Essay." Not only is atropine antagonistic in action to that 
condition of the sudoriparous glands resulting in the sweats of disease, 
but it equally antagonizes the hyperidrosis produced by such drugs as 
jaborandi. 

In the treatment of that form of phthisis known as caseous pneu- 
monia, atropine has an important place, quite irrespective of its power 
to arrest the sweats. As Dr. Fothergill, of London, and myself, nearly 
simultaneously ascertained, it has an influence on the progress of these 



BELLADOXXA. 443 

cases, and a curative effect that is often very remarkable. The author 
has observed with regret that some of those who have found this 
remedy useless, were entirely mistaken as to the character of the 
cases in which atropine has proved beneficial. As a remedy for the 
caseous inflammation, without regard to sweating, the period when 
the degree of benefit above referred to may be expected from it, is the 
stage of deposit immediately succeeding the stage of catarrhal inflam- 
mation, and before softening and extrusion. 

Hypodermatic Use of Atropine. — The solution usually employed 
for this purpose is two grains of the sulphate of atropine to an ounce 
of distilled water, the dose of which ranges from two to five minims. 

There are two forms of neuralgia in which the subcutaneous use 
of atropine has been most signally useful : tic-douloureux and sciatica, 
more especially the latter. Atropine is not as effective in the treat- 
ment of the neuralgias in general as morphine, and the systemic effects 
of the former are much more unpleasant than those caused by the lat- 
ter. Nevertheless, when morphine fails or disagrees with the patient, 
atropine may be used with confident expectation of its affording re- 
lief. We owe to Hunter our knowledge of the fact that atropine has 
a very special utility in tic-douloureux and sciatica. The merely sub- 
cutaneous injection of atropine does not afford the same degree of 
relief as its deep injection in the neighborhood of the affected nerve- 
trunk. Furthermore, a decided impression must be made on the cere- 
brum, in order to obtain the best results. The largest doses compati- 
ble with the safety of the patient must be used — generally the one 
fiftieth of a grain to the one thirtieth. If the remedy is employed in 
sufficient quantity, and well inserted into the tissues above the nerve, 
decided curative results may be expected from it in these two forms 
of neuralgia. When relief follows the injection of atropine, it is apt 
to be more permanent than when the same degree of relief is obtained 
from morphine. We have the high authority of Dr. Anstie for the 
assertion that atropine is exceptionally serviceable in peri-uterine and 
dysmenorrhoeal neuralgia. Dr. Weir Mitchell asserts that atropine 
in traumatic neuralgias is " simply useless," and, as his power of ac- 
curate observation is unquestioned, and his clinical opportunities vast, 
we may accept this conclusion as final. 

Muscular cramp, from injuries to the nerve-trunk, are often remark- 
ably relieved by injections of atropine into the substance of the affected 
muscles. The so-called "late rigidity," as the result of which the 
members may be put into very injurious positions, is occasionally re- 
moved or diminished by the same expedient — viz., injecting a small 
quantity of atropine (yj-g- of a grain) into the contracted muscles. 
This result does not ameliorate the condition of the patient to any 
greater extent than that of affording relief to an inconvenient de- 
formity. 



444 EXCITO-MOTORS. 

The insomnia of mental disorders, and of delirium tremens, may be 
overcome by the hypodermatic injection of atropine when the follow- 
ing indications for its use are present : Coma vigil, great restlessness, 
weak action of the heart, coldness of the surface, cyanosis, clammy 
sweat. When there is a condition of hyperemia of the cerebro-spinal 
centers, excitement with elevated pulse-rate and increase of arterial 
tension, atropine can only do harm. 

The treatment of asthma by belladonna, administered by the stom- 
ach and in the form of fumigation, has already been referred to. The 
hypodermatic injection of atropine is much more effective. From y-|- ¥ 
to -g^ of a grain may be used for this purpose ; but, as the relief comes 
from the systemic effect, it is not necessary to inject the solution in the 
neighborhood of the pneumogastric, as practiced by Courty. In order 
to procure the greatest relief, the injection should be made at the be- 
ginning of the asthmatic paroxysm, and succeeding attacks should be 
anticipated by inducing atropinism at the first warning of a seizure. 

Vomiting of pregnancy, when obstinate and resisting other means, 
is sometimes arrested promptly and permanently by the subcutaneous 
injection of atropine in small quantity (y^-g- of a grain). Sea-sickness 
is relieved in the same way. In these maladies, it is better to insert 
the injection in the epigastrium. 

Cramp of the hollow muscular organs — hepatic, intestinal, uterine, 
and rencd colic — may all be relieved by the subcutaneous injection of 
atropine, but the most satisfactory results are produced by the com- 
bined use of atropine and morphine. 

External Application of Belladonna Preparations. — The 
chloroformic solution of atropine is an excellent external application to 
relieve pain in nerves superficially situated. fy Chlorof ormi, spts. viui 
rect., aa 5 ss ; atropine, grs. v. M. Sig. : Apply on lint to painful part, 
and cover loith oiled silk. The same application to the epigastrium 
sometimes arrests obstinate vomiting, cerebral or reflex, as, for example, 
the vomiting of pregnancy, sea- sickness, etc. A belladonna-plaster is 
an excellent application to relieve the chest-pains of phthisis, to allay 
irritability of an over-excited heart, to diminish the pains and soreness 
of lumbago, myalgia, etc. 

Excessive siceating of a part, as, for example, unilateral siceating of 
the head, may be removed by brushing over the affected surface a 
solution of atropine (grs. iv — f j). 

There is no doubt that belladonna has the power to arrest the secre- 
tion of milk, in the same way that it stops the cutaneous transpira- 
tion, for the milk-gland is only an enlarged sebaceous gland whose 
function is differentiated from that of other sebaceous glands of the 
body. When it is desirable to arrest the secretion of milk, the gland 
may be enveloped by a belladonna-plaster, or the ointment of bella- 
donna may be carefully rubbed into the integument. These are rather 



BELLADONNA. 445 

disagreeable, sticky applications, which soil the clothing. A much 
more elegant method of applying this treatment is to envelop the 
breast in lint wet with a solution of atropine, four grains to the 
ounce of rose-water. As systemic effects may be produced by such an 
application, when the pupils dilate and the mouth becomes dry, it 
should be removed. Inflamed breasts may be treated in the same way. 
The mode of action of the belladonna preparations is quite obvious : 
the irritability of the terminal filaments of the nerves is allayed by the 
direct action of the atropine, and the arterioles are made to contract, 
thus diminishing the blood-supply to the inflamed tissue. 

Other superficial inflammations are subdued by the same treatment, 
as, for example, abscesses, boils, carbuncles. A plaster made of bella- 
donna extract may be kept in contact with the inflamed tissue, or the 
solution of atropine, above recommended, may be used. 

Pruritus of the, vulva, vaginismus, fissure of the anus, are some- 
times relieved, as if by magic, by the use of the atropine solution 
above recommended. 

Whenever atropine is used locally for the relief of inflammatory 
pain and swelling, the efficiency of the application is much increased 
by the addition of morphine, or morphine and chloral, according to for- 
mulae to be given hereafter in the article on the latter drug. 

Secondary Products of Atropine. — Some remarkable products 
have lately been obtained from atropine by chemical processes. The 
first step consisted in the. discovery, by Kraut and Lossen, simultane- 
ously, that atropine may be split up into tropine and tropic acid. Sub- 
sequently, Prof. Ladenburg succeeded in the synthesis of atropine by a 
combination of these two secondary j)roducts. If the salts of tropine 
are treated with dilute hydrochloric acid, alkaloids are produced, to 
which Ladenburg has given the name tropeins. Homotropine is an 
alkaloid obtained from the amygdalate of tropine. The artificial atro- 
pine, prepared as above described, has precisely the same effects as the 
original alkaloid. 

Effects of Homotropine. — The preparation of this base now used 
is the hydrobromate. The physiological action of this new salt has 
been studied by Ringer and Tweedy, among others. Ringer finds that, 
like atropine, homotropine paralyzes and tetanizes, but the tetanizing 
effect, which follows in forty-eight hours or more in the former, occurs 
at once in the latter. The paralyzing action is not in the nerves or 
muscles, for they respond to electrical stimulation, but in the cord, 
which is also the case with atropine. Homotropine, like atropine, in- 
creases the action of the heart by paralyzing the intra-cardiac inhibi- 
tory apparatus, and it also antagonizes muscarine. In man there is a 
marked distinction as regards the action of atropine and homotropine 
on the heart : while the former accelerates the heart considerably, the 
latter retards the beat from ten to twenty per minute, and also makes 



446 EXCITO-MOTORS. 

the action irregular. Homotropine also antagonizes the action of pilo- 
carpine, but it requires relatively more than of atropine to accomplish 
this result. Ringer sums up his observations with the remark, " Ho- 
motropine, then, appears to possess many of the properties of atropine, 
but in a weaker degree." 

Tweedy remarks that, as regards the action of atropine and homo- 
tropine relatively on the eye, the action of homotropine on the iris and 
ciliary muscle is really very powerful while it lasts. It widely and 
fixedly dilates the pupil in from fifteen to twenty minutes, and it acts 
on the accommodation in an equally rapid manner. Its effects pass 
off rapidly, and in twenty-four hours the accommodation is restored, 
although the pupil is yet a little dilated. The application of homo- 
tropine solution to the eye is entirely unirritating. For these reasons 
homotropine becomes a valuable substitute for atropine in ocular thera- 
peutics, but it can not be substituted for atropine in the general dis- 
eases in which the latter has been found useful. 

Authorities referred to : 

Bartholotv, Dr. R. Prize Essay of the American Medical Association, 1869. The 
Physiological Effects and Therapeutical Uses of Atropia and its Salts. 

Ibid. Manual of Hypodermatic Medication, fourth edition, 1882. 

Bezold und Bloebaum. Untersuch. aus. phys. Laborat. in Wurzburg. Quoted by 
Stille. 

Botkin, Dr. S. VirchouPs Archiv, vol. xxiv, p. 85. 

Donders. On the Anomalies of Accommodation and Refraction of the Eye, Sydenham 
Society edition. 

Eulenburg, Dr. Albert. Lehrbuch der functionellen Nervenkrankheilen, Berlin, 1871, 
p. 168. 

Fluckiger and Hanbury. Pharmacographia, pp. 407, 411. 

Fraser, Dr. Thomas R. An Investigation into some Tetanic Symptoms produced by 
Atropia in Cold-blooded Animals. From " Transactions of the Royal Society of Edin- 
burgh," vol. xxv. 

Note. — Other references omitted for lack of space, but they are to be seen in all edi- 
tions previous to the fourth. 

Stramonium. — Leaves and seed of Datura stramonium Linne (Nat. 
Ord. Solanaceae). (U. S. P.) Stramoine, Fr. ; Stechapfel, Ger. 

Stramonii Folia. — Stramonium-leaves. 

Stramonii Semen. — Stramonium-seed. 

Extractum Stramonii. — Extract of stramonium. Dose, gr. \ — 
gr. ss. 

Tinctura Stramonii. — Tincture of stramonium. Dose, t\\ v — 3 ss. 

Extractum Stramonii Fluidum. — Fluid extract of stramonium. 
Dose, Til, j — -nx v. 

Composition. — The alkaloid of stramonium — daturine — is chemi- 
cally and physiologically nearly identical with atropine. It is con- 
tained in the seeds in the proportion of about one tenth per cent, and 
in the leaves in much smaller quantity. It exists in the plant in com- 



HYOSCYAMUS. 447 

bination with malic acid. The seeds contain a fixed oil in considerable 
quantity. 

Antagonists, Incompatibles, and Synergists, are the same as 
for belladonna. In the case of poisoning by stramonium, which is not 
uncommon in this country, the seeds, which usually are taken by chil- 
dren, must be evacuated by an emetic. Unless distinct symptoms fol- 
low, no further treatment may be necessary ; if, however, marked 
dilatation of the pupil, hallucinations, and active delirium are produced, 
the physiological antagonist becomes necessary. Tincture of opium 
should be administered until some contraction of the pupil, lessening 
of the pulse-rate, and cessation of the delirium, occur. If then, normal 
sleep comes on, the pupil, heart, and lungs functionating normally, no 
further interference will be necessary. In cases of poisoning in chil- 
dren, it is particularly desirable to employ the opium with caution, 
since opium narcosis may readily be substituted for stramonium-poi- 
soning. 

Hyoscyamus. — Leaves of Hyoscyamus niger Linne (Nat. Ord. So- 
lanacece), collected from plants of the second year's growth. (IT. S. P.) 
Jusquiame, Fr. ; Bilsenkraut, Ger. 

Extractum Hyoscyami Alcoholicum. — Alcoholic extract of hyoscy- 
amus. Dose, gr. \ — gr. j. 

Abstraction Hyoscyami. — Abstract of hyoscyamus. Dose, gr. ss 

— gr. ij- 

Extraction Hyoscyami Fluidum. — Fluid extract of hyoscyamus. 
Dose, Til v — 3 ss. 

Tinctura Hyoscyami. — Tincture of hyoscyamus. Dose, 3 ss — § ss. 

Composition. — Hyoscyamus contains an active principle {hyoscya- 
mine), a fatty oil, and the leaves are rich in nitrate of potassium. The 
seeds possess a larger quantity of hyoscyamine than the leaves. 

Hyoscyamince Sulphas. — Sulphate of hyoscyamine. The neutral 
sulphate of an alkaloid prepared from hyoscyamus. Small golden- 
yellow or yellowish-white scales or crystals, or a yellowish-white, 
amorphous powder, deliquescent on exposure to air ; odorless, having 
a bitter and acrid taste, and a neutral reaction ; very soluble in water 
and in alcohol. (U. S. P.) Dose, gr. -^ — gr. 3. 

Antagonists, Incompatibles, and Synergists, are the same as 
for belladonna. The observation of Ladenburg, that hyoscyamine and 
duboisine are identical, is important, and if confirmed will facilitate 
the introduction of the latter into practice. As hyoscyamine is diffi- 
cult to procure and very expensive, and as duboisine, on the other 
hand, will probably be very readily procured in any quantity, it is 
certain that the latter will be substituted for the former. Chemical 
facts of this kind must be acted on with caution. Identity of chemi- 
cal constitution does not always mean identity in physiological action 



448 EXCITO-MOTORS. 

and in therapeutical power. Differences in molecular arrangement, 
not appreciable by chemical analysis, may influence, to a great extent, 
the mode of action. The clinical facts do not, thus far, warrant the 
adoption of the view that hyoscyamine and duboisine are mutually 
convertible. 

Physiological Actions. — As atropine, daturine, and hyoscyamine 
are similar if not identical in chemical composition and in physiologi- 
cal action, the remarks already made in regard to the actions and uses 
of belladonna are applicable to stramonium and hyoscyamus. 

To these alkaloids must be added duboisine, which by Ladenburg 
is held to be identical with hyoscyamine. Studied from the physio- 
logical standpoint, daturine and hyoscyamine are regarded as identical 
in their effects by Oulmont and Laurent. As daturine is not employed, 
owing to its scarcity, and as hyoscyamine has been the subject of con- 
siderable study and clinical observation, we refer, in the following re- 
marks, wholly to this alkaloid. 

Hyoscyamine, as it occurs in commerce, prepared chiefly by Merck, 
of Darmstadt, is in two forms, a yellowish-white crystalline solid, 
which is represented as chemically pure, and a dark, resinous mass, 
having a strong, mouse-like odor, which is rather a concentrated ex- 
tract, but appears to be little if at all inferior to the pure alkaloid. It 
is recommended by Prideaux to dissolve it in a mixture of sulphuric 
ether, alcohol, and water, in the proportion of one grain to twenty 
minims — alcohol eight minims, spirit of sulphuric ether six minims, 
and water ten minims. It may be administered, hypodermatically, in 
this form, or, if too strong, by the addition of equal parts of spirit 
and water ; and it may be prepared for internal use from the above 
solution, by adding water and any flavoring sirup. The hydriodate is, 
however, the best form for administration, as it is freely soluble in 
water. The great variations in the dose of the alkaloid are due to the 
fact that much of the so-called hyoscyamine is merely a concentrated 
extract. The dose, by subcutaneous injection, ranges from one six- 
tieth of a grain to one fourth, and by the stomach from one sixtieth 
to one grain. 

Hyoscyamine causes the same dryness of the mouth, dilatation of 
the pupils, flushing of the face, rapid action of the heart and of the 
lungs, the busy delirium with hallucinations and illusions, which are 
caused by atropine, but its effects in these directions are less in degree. 
In the various observations which have now been made on man, with 
the considerable doses which have been found necessary in some cases, 
it has been definitely ascertained that hyoscyamine has somewhat less 
than atropine of the deliriant action and much more hypnotic effects. 
As regards the mechanism of its action on the pupil, on accommoda- 
tion, on the heart and respiration, there is no actual difference between 
the two alkaloids. 



HYOSCYAMUS. 449 

The elaborate investigations of MM. Oulmont and Laurent have 
conducted them to the following conclusions : Hyoscyamine and datu- 
rine act especially on the sympathetic system, in small or moderate 
doses, stimulating the vaso-motor fibers and raising the arterial ten- 
sion, and in large doses paralyzing the vessels and lowering the arterial 
tonus. These effects are produced after section of the vagi. These 
alkaloids differ in the effect on the heart — hyoscyamine rendering the 
cardiac movements more regular, and daturine causing intermittence. 
By direct contact, both alkaloids slow and finally stop the heart's ac- 
tion. Both accelerate the respiratory movements. In moderate quan- 
tity both increase the intestinal movements ; in large doses arrest them. 
As regards the nervous system of animal life, they are both without 
action on the motor functions, but in toxic doses they blunt the cuta- 
neous sensibility. They do not affect the contractility of muscular 
fiber. Their action in dilating the pupil is due to stimulation of the 
sympathetic, and not to paralysis of the third nerve. The various phe- 
nomena arising from the administration of these alkaloids are referred 
by Oulmont and Laurent to the circulatory disturbances — to the in- 
creased distribution of blood. The action is soon ended, the alkaloids 
being eliminated by the urine. 

Notwithstanding the freedom with which hyoscyamus and its alka- 
loid, hyoscyamine, are given, rarely are there any unpleasant effects. 
Empis, however, has reported some cases in which toxic symptoms 
happened from medicinal doses. These must have been examples of 
idiosyncrasy, for in the discussion which ensued, Joffroy, Damaschino, 
and others, expressed themselves strongly against the probability of 
serious effects from doses within safe limits. 

Therapy. — The possession of decided hypnotic qualities has led to 
the use of hyoscyamine in the treatment of various mental disorders 
(Prideaux, Lawson, and others). Prideaux makes the important prac- 
tical distinction, that it acts with different degrees of rapidity and 
potency under varying conditions of insanity. In acute mania with 
depression, one sixteenth of a grain will have a marked effect, while 
in the excitement of chronic mania large doses will be necessary. In 
chronic mania with exacerbations, he gives one quarter, one half, and 
even one grain by the stomach, or one tenth of a grain subcutaneously. 
The latter mode of administration he regards preferable in these cases. 
In cases of mania with great motor excitement, and of a destructive 
character, Prideaux regards hyoscyamine as " the most rapid and reli- 
able narcotic we possess." In the epileptic mania of the epileptic 
status, he says, it diminishes the number and violence of the attacks. 
In delusional insanity he finds it brings about, under favorable circum- 
stances, mental restoration. In chronic dementia, with destructive 
tendencies and sleeplessness, improvement is sometimes noted from the 
persistent use of small doses. Reinhard also has administered this 
29 



450 EXCITO-MOTORS. 

agent in the dose of a milligramme (about one fifteenth of a grain) 
subcutaneously in cases of mania and epilepsy, with distinctly good 
results. In eight of fifteen cases of mania, calmative effects were 
produced and permanent good was accomplished ; and in five of twelve 
epileptics with maniacal attacks, the number and severity of the seiz- 
ures were lessened. Drs. Sapilli and Riva, eminent Italian alienists, 
have found hyoscyamine very useful in recurrent mania. Gill, Ringer, 
and Lawson have also had good effects from hyoscyamine, in suitable 
cases, as an hypnotic. 

Stramonium and hyoscyamus may be used like belladonna for the 
relief of painful affections, the neuralgim ; but they possess no special 
advantages over their more powerful congener. Oulmont has used the 
hypodermatic injection of hyoscyamine with remarkable success in 
several cases of neuralgia, but he does not regard it as more conspicu- 
ous and rapid in this disease than are opium and belladonna. Stramo- 
nium is used with advantage in the treatment of dysmenorrhoea. 
3 Ext. stramonii, ext. hyoscyami, ext. opii, aa gr. vj. M. Ft. pil. no. 
xij. Sig. : One pill every three, four, or six hours. This combination 
gives great relief in dysmenorrhoea, and may also be serviceable in 
neuralgia. 

In affections characterized by spasm, as asthma, laryngeal cough, 
hepatic, intestinal, renal, and uterine colic, stramonium and hyoscyamus 
may be given with advantage, in place of or in combination with bella- 
donna. The hypodermatic injection of hyoscyamine or daturine is an 
excellent expedient for procuring relief in these cases, but these alka- 
loids are not more effective than atropine. Hyoscyamus, especially in 
the form of tincture, is frequently prescribed in irritable states of the 
bladder due to the presence of stone, enlargement of the prostate, and 
in catarrh of the bladder arising by transference of irritation from the 
urethra. It should not be forgotten that liquor potassae, so much pre- 
scribed in a mixture with hyoscyamus, is incompatible. 

M. Oulmont refers, in terms which may seem to be exaggerated, 
to the great efficiency of hyoscyamine in the treatment of mercurial 
tremor, senile tremor, paralysis agitans, locomotor ataxia, and tetanus. 
In mercurial and senile tremor cures were obtained, but, as might be 
expected, only amelioration in paralysis agitans, locomotor ataxia, and 
tetanus. The remarkable benefit obtained from this remedy in paral- 
ysis agitans is testified to by Empis, Joffroy, Charcot, and many other 
observers. The dose which Oulmont found effective was the one 
thirty-second of a grain of hyoscyamine, gradually increased to the 
one fifteenth of a grain. 

The hypnotic quality is much more conspicuous in hyoscyamus than 
in belladonna or stramonium. In children it has long been known that, 
when opium is not well borne, hyoscyamus is an efficient substitute. 
Recent experience in asylum practice has shown that hyoscyamus in 



HYOSCYAHUS. 451 

large doses is a very valuable hypnotic. According to Dr. Campbell, 
two and a half drachms of the tincture are equivalent in hypnotic 
power to thirty grains of chloral hydrate. In order to procure effi- 
cient hypnotic effects, from two drachms to an ounce of the tincture 
is necessary, and this large quantity appears to be free from danger. 

Extract of hyoscyamus is used in combination with purgatives, with 
the object — which abundant clinical observation confirms — of render- 
ing their operation more efficient, and, at the same time, less drastic. 

The ointment of stramonium is a favorite application to irritable 
ulcer 'S, superficial inflammations, etc . 

Hyoscine. — This is a new alkaloid obtained artificially from hyos- 
cyamus by Ladenburg. It forms a crystalline combination with hydri- 
odic acid, and an amorphous salt with hydrochloric. These salts dis- 
solve freely in water. The solution employed by Edfelsen for admin- 
istration by the stomach contained about fa gr. to the tablespoonf ul, 
and for subcutaneous injection, y^-g- gr. to one minim. These are suit- 
able doses for administration. 

The physiological effects of hyoscine have been studied by Laden- 
burg, the discoverer ; by Edfelsen, and others. Generally speaking, 
the effects of this agent correspond quite closely to those of atropine, 
but in corresponding doses the latter is more powerful. When admin- 
istered subcutaneously, hyoscine acts in two to twelve minutes, by the 
stomach in about fifteen minutes. It causes more drowsiness and sopor, 
and less delirium than atropine, but like the latter dilates the pupil, in- 
creases the rate of the cardiac and respiratory movements, and red- 
dens the skin. According to Gnauck, the pulse is first slowed eight to 
twenty beats per minute, and after ten to twenty minutes rises. The 
same phenomenon is observed from atropine in some subjects, but is 
not so pronounced. Dilatation of the pupil does not always occur 
after the stomachal administration. Sleep comes on in twenty to 
thirty minutes, preceded by a feeling of lassitude, and is deep and 
quiet, but is followed by headache and vertigo. 

Instilled into the eye, hyoscine is a more energetic mydriatic than 
atropine, dose for dose (Emmert). One part of the hydriodate to one 
thousand of water is the solution used by Emmert, and this he finds 
more active than a half-per-cent solution of atropine. 

Hyoscine has been employed in various diseases requiring a sopo- 
rific and anodyne agent. In general, it can be used in the same cases 
as atropine, but, as it possesses more decided antispasmodic effects, it 
may prove more valuable. By Ladenburg it has been used success- 
fully in whooping-cough, in asthma, and in enteralgia. Half the cases 
of whooping-cough were relieved, and all of the cases of asthma were 
more or less benefited, some decidedly so. 

In ophthalmic practice, hyoscine can be substituted for atropine. 
It causes more prompt and decided, but less persistent, dilatation of 



452 EXCITO-MOTORS. 

the pupil, and it is less poisonous (Emmert). It is applicable to the 
same purposes in eye-diseases as those in which atropine is now em- 
ployed. 

Authorities referred to : 

Bucknill and Tuke. Manual of Psychological Medicine, London, 1874, p. 727. 

Campbell, Dr. Journal of Mental Science, No. lxxx, 1871. 

Edfelsen und Illing. Ueber die therapeutische Verwendung des Hyoscinum hydrochlo- 
ricum und hydriodicum. Centralblatt f d. med. Wissensch., No. 23, 1881. 

Emmert, Dr. Correspondenz-Blatt, January 15, 1882; by London Medical Record, 
February, 1882. 

Empis, Dr. Hyoscyamine, accidents causes par son emploi. Bull. Gen. de Therap., 
Juin IS; 1881. 

Fronmuller, Dr. Klinische Studien uber die schlafmachende Wirkung der narkotischen 
Arzneimittel, Erlangen, 1875, p. 70. 

Gnauck, Dr. A. Ueber die Wirkungen des Hyoscine. Centralblatt fur die med. Wis- 
sensch., No. 45, 1881. 

Husemann, Dr. Theodor. Handbuch der gesammten Arzneimittellchre, zweiter Band, 
p. 1115, et seq. 

Ladenburg, Prof. Dr. Ibid. No. 23, 1881. 

Laurent, M. le Dr. De V Hyosciamine et de la Daturine. These. 

Oulmont, M. le Dr. De V Hyosciamine et de son Action dans les Nevroses. Bulletin 
General de Therapeutique, vol. lxxxiii, p. 481. 

Prideaux, E. The Action and Uses of Hyoscyamine. Lancet, 1879, September 27, 
October 4 and 11. 

Reinhard, Dr. C. Archiv fur Pschy. und Nervenkrankh., Band xi, p. 121. 

Duboisia. — Duboisia myoporoides, of the Solanacece. 

Preparations. — There are no official preparations. It has been 
used chiefly in the form of extract, and salts of the active principle. 
The dose of the extract is gr. \ — J. 

Composition. — The important constituent is an alkaloid — duboi- 
sine — which possesses the medicinal powers and properties of the plant. 
It combines with acids to form salts which are freely soluble in water. 
As regards its chemical relations, duboisine strongly resembles atro- 
pine, but differs in some particulars ; according to Ladenburg, duboi- 
sine is identical with hyoscyamine. The dose of a salt of duboisine is 
yfo- to A of a grain. 

Antagonists and Incompatibles. — The caustic alkalies destroy 
the active principle, and consequently prescriptions containing them 
will be inert, except as to the effects of the alkali. The physiological 
antagonists are the same as those of atropine ; thus physostigmine and 
muscarine counterbalance the action of duboisine in almost the entire 
range of power, and opium in a limited degree. Duboisine antagonizes 
pilocarpine, as respects, at least, the most conspicuous and important 
properties of the latter. In case of poisoning, emetics and the stom- 
ach-pump must be used, and the systemic effects opposed by the sub- 
cutaneous use of physostigma, muscarine, or morphine, cautiously, and 



DUBOISIA. 453 

possibly pilocarpine ; but further researches are necessary as to the 
antagonism of the last named. 

Synergists. — The actions of duboisia are promoted by the other 
agents of the group, especially by belladonna, stramonium, and hyoscy- 
amus. The effects of atropine and duboisine correspond to a remark- 
able extent, but there are points of difference, as follows : Duboisine 
is twice or more soluble in water than atropine ; it has stronger basic 
properties, and it reacts differently to sulphuric acid and bichromate 
of potassa ; it is less irritating to the conjunctiva, dilates the pupil 
more promptly, and its effects subside earlier (Gerard). 

Physiological Effects. — Dryness of the mouth, thirst, and some 
difficulty in swallowing, soon follow the administration of duboisia, and 
more speedily after the subcutaneous injection of the alkaloid. The 
pulse is considerably accelerated ; the arterial tension rises, the face 
flushes, the pupil dilates, and the accommodation is paralyzed. Some 
frontal headache, tinnitus aurium, giddiness, and restlessness, especially 
in sleep, are experienced. Certain motor symptoms — uncertain gait, 
awkwardness of movement in walking, and muscular paresis — occur 
(Gubler). In animals mental excitement or delirium has been noted, but 
no confirmatory or opposing observations on man have thus far been re- 
ported. The tetanic symptoms which occur after some days in frogs poi- 
soned by atropine, take place under the same conditions from duboisia. 

The acceleration of pulse and rise of tension first produced by du- 
boisia do not persist ; the pulse-rate and the tension fall after some 
hours, the excitement subsides, and a condition of stupor comes on 
which is not sleep, although it favors sleep (Gubler). I can confirm 
these important observations on the cerebral effects of duboisia. 

Therapy. — Thus far duboisine has been used only in ocular thera- 
peutics. The author has prescribed it in a case of puerperal mania 
with excitement, on the suggestion of M. Gubler, and with apparent 
advantage. There was always an increase of the maniacal excitement 
for a few hours after the hypodermatic injection, but this was followed 
by the condition of stupor and mental calm. The improvement was 
rapid, and followed so closely the administration of the remedy that 
he could not doubt it was propter and not merely post hoc. 

As respects its use in ophthalmic diseases, it may be stated in gen- 
eral that duboisine is applicable under the same conditions as atropine, 
to which it is to be preferred, in many cases, it is probable. 

The advantages of duboisine, as compared with atropine, are its 
greater rapidity of action in effecting dilatatio?i of the pupil and pa- 
ralysis of accommodation, the less irritation of the conjunctiva, and 
the more rapid recovery from the effects. It is, therefore, much more 
useful than atropine for determining the refraction of the eye, and for 
use in ocular therapeutics in general. 

Some unpleasant cerebral effects have been observed after instilla- 



454 CEREBRAL EXCITANTS. 

tion into the eye (Seely). The author was given the opportunity, by 
the kindness of Dr. Seely, to examine the patient — the first instance 
in which such phenomena were observed — who experienced faintness 
and strange sensations in the head ; but they were entirely subjective 
and mental, as no change in the circulation or respiration was to be 
seen. Since that case there have been several examples of the sys- 
temic action of duboisine after its instillation into the eye. 

To relieve the night-sweats of phthisis and the various neuroses of 
the respiratory organs, and to stimulate the action of the heart, du- 
boisine may take the place of atropine. As an antagonist to mor- 
phine it is equally as effective as atropine, but, as a hypnotic and ano- 
dyne, superior to the latter. 

Authorities referred to : 

Bancroft, Dr. Joseph. The Lancet, March 2, 18*78. 

Gerrard, Mr. London, Medical Record, vol. vi, 1878, p. 156. 

Gubler, Prof. A. Bull. Gen. de Therap., vol. xciv, p. 426. 

Lauersau, de, Prof. Lull. Gen. de Therap., supra, p. 362. 

Norris, Prof. W. F. The American Journal of the Medical Sciences. April, 1879, pp. 
466, et seq. Duboisia as a Mydriatic, etc. 

Ringer, Prof. Sydney. Ttie Lancet, supra. 

Seely, Prof. W. W. Lancet and Clinic for 1879, January, February. Various arti- 
cles on the use of Duboisine. 

Tweedy, Mr. John. The Lancet, supra. On the Mydriatic Properties of Duboisia, etc. 

Weeker, Dr. L. Ball. Gen. de Tlierap., supra, p. 337. De Vemploi compare de Vese- 
rine, de V atropine, et de la duboisine en therapeutique oculaire. 



B.— AGENTS EXCITING THE FUNCTIONAL ACTIVITY OF THE CEREBRUM. 

To this group belong those remedies usually classed together under 
the designation of antispasmodics. They are to a slight degree car- 
diac stimulants ; they increase the cutaneous circulation, and promote 
diaphoresis ; they also stimulate the bronchial mucous membrane, and 
favor expectoration. As a result in part of the increased rapidity of 
the circulation, the functions of the brain become slightly more active, 
ideas flow more freely, irregular mental excitement and muscular hy- 
perkinesia are moderated, and an orderly feeling of well-being is estab- 
lished. These effects are probably in part due to a direct action of 
these agents on the gray matter of the hemispheres, but our knowledge 
does not at present permit an exact statement of the nature of this 
impression. These agents do not in any quantity suspend the func- 
tions of the brain, and the temporary increase of activity which they 
produce is not followed by manifest depression. 

Camphora. — Camphor. Camphre, Fr. ; Campher, Ger. A stea- 
ropten derived from Cinnamomum camphora F. Nees et Ebermaier 
(Nat. Ord. Lauracece), and purified by sublimation. (XT. S. P.) 



CAMPHOR. 455 

Aqua Camphorce. — Camphor-water. Dose, 3 j — 1 j. 

Linimentum Camphorce. — Camphor-liniment. (Camphor, 20 parts ; 
cotton-seed oil, 80 parts. ) 

Linimentum Saponis. — Soap-liniment. (Soap, camphor, oil of rose- 
mary, alcohol, and water.) 

Spiritus Camphorce. — Spirit of camphor. (Camphor, 10 parts ; 
alcohol, 75 parts ; water, 20 parts.) Dose, in, v — r\ xx. 

Camphora Monobromata. — Monobromated camphor. Dose, grs. 
jj — g r s. x. Colorless, prismatic needles or scales, permanent in the 
air and unaffected by light, having a mild camphoraceous odor and 
taste, and a neutral reaction. Almost insoluble in water ; freely solu- 
ble in alcohol, ether, chloroform, and fixed oils ; slightly soluble in 
glycerin. 

Composition and Properties. — Camphor is found in colorless, 
translucent, crystalline masses. One part dissolves in about 1,300 
parts of water, but it is freely soluble in alcohol, ethers, oils, chloro- 
form, bisulphide of carbon, etc. Its odor is peculiar and characteristic. 
The formula for camphor is the following : C 10 H ]6 O. By distillation 
with chloride of zinc it is converted into cymol, and by oxidizing 
agents into camphoric and camphretic acids. 

Antagonists and Incompatibles. — The addition of water pre- 
cipitates camphor from its spirituous solution. Alkaline and earthy 
salts, for example sulphate of magnesium, separate from its solution 
the small quantity of camphor contained in aqua camphora?. Coffee, 
the arterial sedatives, cold, and depressing causes generally, antago- 
nize its physiological action. 

Synergists. — All the remedies of this group, and alcohol, opium, 
and narcotic substances, increase the effects of camphor. 

Physiological Actions. — Applied to the skin, camphor produces 
redness, heat, and superficial inflammation, if the contact be sufficiently 
prolonged ; to an open wound its effects are still more severe. Its 
taste is hot, aromatic, and pungent. In the stomach it causes a sensa- 
tion of heat, and may excite in large doses inflammation and ulcera- 
tion. The symptoms common to irritant poisons may, therefore, be 
produced by camphor. After experimental doses in animals camphor 
has been detected in the blood of the mesenteric and portal vein, but 
not in the chyle or urine. In moderate doses (medicinal) it increases 
the action of the heart, elevates the arterial tension, and promotes 
cutaneous transpiration ; it also produces mental exhilaration, even a 
gay and lively intoxication, and allays pain. In toxic doses, in addi- 
tion to the local irritant action on the gastro-intestinal mucous mem- 
brane, and the consequent systemic effects, it lowers the pulse, the 
skin becomes pale, and the surface cold and moist, stupefies, dimin- 
ishes the reflex functions of the spinal cord, and causes convulsions, 
insensibility, and death ; but these cerebral phenomena are not sepa- 



456 CEREBRAL EXCITANTS. 

rable from the reflex effects, on the nervous centers, of the violent 
gastro-intestinal disturbance. Sometimes dysuria has been caused by- 
camphor, and, in small doses, owing doubtless to the merely stimulant 
effects on the circulation, it increases the sexual appetite ; but, in large 
doses, it is antaphrodisiac. 

Camphor, after absorption, is eliminated chiefly by the skin and 
bronchial mucous membrane, hence the breath and sweat of those using 
this substance smell of it strongly ; but, when much camphor is taken 
in the solid form, it escapes with the f seces. 

Therapy. — Camphor enters into the composition of many denti- 
frices. 

Camphor is contraindicated in all inflammatory affections of the 
gastro-intestinal mucous membrane. In hysterical vomiting a few 
drops of the spirit (two to five), every half -hour or hour, will often 
give relief. Camphor is an efficient remedy in summer diarrhoea. It 
is usually combined with opium : I£ Spirit, camphorae, tinct. opii, aa 
f ss. M. Sig. : Ten to thirty drops every two, three, or four hours. 
I£ Aqua camphoraa, § iij ; tinct. lavendulse comp., J j ; tinct. opii, 3 j 
— 3 ij. M. Sig. : A tablespoonful every hour or two. This is an ex- 
cellent formula, omitting the opium, for flatulence, especially hysterical 
flatulence and the flatulent colic which so often occurs during the cli- 
macteric period. For the preliminary diarrhoea of Asiatic cholera 
camphor is largely used, and with very obvious benefit. A drop or 
two of the saturated tincture (Rubini's), or five to ten drops of the 
spirit, may be given with a little laudanum every half-hour or hour. 
Oppolzer gave the ethereal tincture with opium : ^ Camphorae, § j ; 
etheris, ? vij ; tinct. opii, 3 j. M. Sig.: Twenty to forty drops, as 
necessary. Camphor, which is very serviceable in the summer diar- 
rhoea of children, may be given to these little subjects in milk, in 
which it is soluble in the proportion of one drachm to four ounces. 

Spirits of camphor, in the form of vapor, is a useful inhalation in 
the incipiency of acute catarrh. Dr. Beard speaks in very enthusias- 
tic terms of a camphor preparation which he has called " cold powder." 
This formula is as follows : " Camphor, five parts. Dissolve in ether 
to the consistence of cream. Then add carbonate of ammonium four 
parts, opium-powder one part." The dose of this ranges from three 
to ten grains. Dr. Beard finds this combination of " great value in 
breaking up colds, when taken in time, and in modifying their force 
when taken late." 

Camphor was formerly much used in the treatment of asthma, but, 
at present, more efficient remedies have taken its place. The mono- 
bromide of camphor has proved decidedly beneficial in whooping-cough. 
Five grains, suspended in mucilage and sirup of tolu, may be given to 
a child three or four times a day. It is most serviceable in the spas- 
modic stage, but will do good at any period. 



CAMPHOR. 457 

Camphor will allay cough and promote . expectoration, hence its 
utility in chronic bronchitis, in capillary bronchitis when stimulants 
are needed, and in emphysema. In the so-called typhoid pneumonia 
camphor is serviceable as a stimulant, in small and frequently-repeated 
doses, to sustain the powers of life during the period of deferves- 
cence. 

In typhus and typhoid fevers, and in the exanthemata generally, 
camphor is used to accomplish two objects — to quiet delirium, subsul- 
tus, or restlessness, and to overcome the cardiac depression. When 
very active interference is unnecessary the following can be used : ^ 
Aqua camphorse, liq. ammonias acetatis, aa § ij- M. Sig. : A table- 
spoonful every two hours. 

Attacks of nervousness and hysteria are relieved by camphor-julep, 
i. e., camphor rubbed up with mucilage. Some cases of delirium tre- 
mens are benefited by camphor, but it is impossible to indicate the 
special condition requiring it. Maniacal excitement, melancholia, and 
erotomania, have also been relieved by this agent, but a great uncer- 
tainty exists as to the indications for its employment. Large doses 
are necessary in these affections, and they should at first be tentative, 
for it is not possible in the present state of our knowledge to predict 
the results of any given trial. On the whole, but little dependence is 
to be placed on camphor ; besides, more certain and effective remedies 
are now available for the treatment of these maladies. 

There appears to be a satisfactory clinical experience as respects 
the use of camphor to allay sexual excitement. Large doses (from ten 
to twenty grains) diminish the venereal appetite and the vigor of the 
erections ; hence the use of camphor in priapism, satyriasis, nympho- 
mania, chordee, etc. The following is a formula of Ricord : I£ Caui- 
phorse, lactucarii, aa 3 j. M. Ft. pil. no. xxx. Sig. : One or tico pills, 
or more, as necessary. For nocturnal seminal losses, with weakness 
and relaxation of the genitalia, the following formula is useful : ^ 
Ergotine (aq. ex., Squibb's), 3ij ; camphora?, 3 j- M. Ft.pil.no. 
xxx. Sig. : Two at bed-hour. A full dose of camphor will often ar- 
rest the strangury produced by blisters. 

Considerable testimony has been collected showing the value of 
camphor as a remedy in senile gangrene, and in hospital gangrene. 
Five to fifteen grains every four hours may be given in an emulsion, 
and powdered camphor may be applied freely to the sloughing surface. 
A clyster of camphor is an effective remedy against ascarides. 

Camphor was a favorite remedy with Dewees for dysmenorrhcea. 
He gave ten grains in a mixture with mucilage and cinnamon-water, 
and repeated the dose in an hour or two if necessary. For after-pains, 
camphor (ten grains), in a mixture with a little morphine (one eighth 
of a grain), is an effective remedy. 

External Uses. — A cataplasm of camphor, morphine, and flax- 



458 CEREBRAL EXCITANTS. 

seed, applied to the cheek, will relieve toothache. Camphorated oil is 
a mild counter-irritant, which is a useful external application for the 
relief of internal inflammations. The solution of camphor in ether has 
been applied locally with benefit in erysipelas. Myalgia, lumbago, 
and neuralgia of superficial nerves, may sometimes be relieved by 
frictions with camphorated oil or soap-liniment. Powdered camphor, 
freely sprinkled over the surface, is one of the means resorted to, and 
sometimes with success, to prevent pitting of the face from variola. 

Authorities referred to : 

Beard, Dr. George M. Archives of Electrology, 1874, p. 272. 

Fluckiger and Hanbury. Pharmacographia, article Camphora. 

Gubler, Dr. Adolphe. Bulletin General de Therapeutique, December 30, 1871. 

Harley, Dr. John. The Physiological Action of Camphor. The Practitioner, vol. 
ix, p. 210. 

Husemann, Dr. Theodor. Handbuch der gesammten Arzneimittellehre, Berlin, 1875, 
zweiter Band. 

Kohler, Prof. Dr. Hermann. Handbuch der phys. Therapeutic. 

Stille, Dr. Alfred. Therapeutics and Materia Medica, vol. ii, article Camphor. 

Trousseau et Pidoux. Traite de Therap. et de Mat. Med., vol. ii, huitieme edition. 

Yon Grisar, V. Pharmakodynamik der ath. Oele, Diss., Bonn, 1873. 

Asafoetida. — Asafoetida. A gum-resin obtained from the root of 
Ferula narthex Boissier, and of Ferula scorodosma Bentham and 
Hooker (Nat. Ord. Umbelliferm, Orthospermm). (IT. S. P.) Asa- 
foetida, Fr. ; TeufelsdrecJc, Ger. 

Emplastrum Asafcetidce. — Asafoetida-plaster. 

Mistura Asafcetidm. — Asafcetida-mixture. Dose, f ss — § ij. 

Tinctura Asafcetidce. — Tincture of asafoetida. Dose, 3 ss — 3 ij. 

Pilulm Asafcetidos. — Pills of asafoetida. (Asafoetida and soap.) 
Dose, 1 — 4 pills. 

Pilulm Aloes et Asafoetida. — Pills of aloes and asafoetida. (Asa- 
foetida, aloes, soap.) Does, 1 — 4 pills. 

Pilulm Galbani Composite. — Compound pills of galbanum. (Asa- 
foetida, galbanum, and myrrh.) Dose, 1 — 4 pills. 

Composition. — About one half of the gross constituents of asafoetida 
consists of resin. This is not wholly soluble in chloroform or ether. It 
contains a peculiar acid (ferulaic acid). Asafoetida also contains a 
sulphureted and phosphureted volatile oil, in the proportion of from 
three to five per cent. This oil is at first neutral, but becomes acid by 
exposure to the air, and evolves sulphureted hydrogen. It possesses 
in a high degree the disagreeable odor of the drug. 

Asafoetida also contains malic acid, and acetic, formic, and vale- 
rianic acids are products of the watery distillation. There is sufficient 
gum present also to form an emulsion with water. 

Antagonists and Incompatibles. — Acids, neutral salts, cold, and 
arterial sedatives, oppose the action of asafoetida. 



ASAFCETIDA. 459 

Synergists. — The gum-resins, the balsams, and the aromatics, es- 
sential oils containing sulphur and phosphorus, and alcohol and ether, 
promote the physiological and therapeutical activity of asafcetida. 

Physiological Actions. — Asafcetida possesses an extremely char- 
acteristic odor, and a pungent, rather hot, and faintly acrid taste. It 
excites by its presence in the fauces an increased flow of saliva. It 
stimulates secretion from the gastro-intestinal mucous membrane, pro- 
motes the appetite, improves digestion, and increases peristalsis. The 
faeces are somewhat softer, and are very offensive from the presence in 
them of sulphur and phosphorus compounds, resulting from the de- 
composition of the essential oil. In large quantity asafcetida causes 
nausea, vomiting, and purging. The active principle (the essential 
oil) undoubtedly slowly diffuses into the blood, for the odor of it is 
detectable in the sweat and breath. Increased action of the heart, a 
higher temperature of the surface (subjectively, at least), more or less 
diaphoresis, and diuresis, have been observed to follow its medicinal 
administration. It acts as a gentle stimulant to the brain, induces a 
feeling of well-being, increases the flow of ideas, and causes, as the 
author has observed in one case, certainly, sufficient exhilaration of a 
pleasant kind to be regarded as an intoxicant. 

Asafcetida is eliminated by the skin, intestinal and bronchial mu- 
cous membrane, and in small part by the kidneys. The functions, of 
all these organs are increased in activity by the local stimulant effect. 
Partly due to the general rise of arterial pressure which it produces, 
partly to its local action in the process of elimination, and partly to its 
phosphorus compounds, asafcetida increases the menstrual flux, and, in 
both sexes, the venereal appetite. 

Therapy. — Asafcetida is used in the country of its habitat as a 
condiment. A little — very little — rubbed on the gridiron, improves 
the flavor of beefsteak. If it were not for its intolerable odor, and for 
the horrible eructations which follow its use, even when disguised in a 
sugar-coated pill, it would be much employed as a stomachic tonic in 
atonic dyspepsia, accompanied by torpor of the intestines. For the 
flatulent colic of infants no remedy is better than mistura asafoetidm, 
which may be given in teaspoonful doses. It is especially in the flatu- 
lence of hysteria and hypochondriasis that this remedy is serviceable. 
It expels the flatus, promotes intestinal secretion and digestion, and 
relaxes the bowels. In this way the mind is relieved, but the action 
of asafcetida extends beyond this improvement in the state of the 
chylopoictic viscera — it induces a condition of mental cheerfulness 
which takes the place of the abnormal mobility of hysteria, and of 
the gloom of hypochondriasis. 

The official pill of aloes and asafcetida is an excellent combination 
for the relief of constipation, when associated with amenorrhoea. It 
is adapted, of course, to those cases in which there is a condition of 



460 CEREBRAL EXCITANTS. 

anaemia rather than of plethora, and in which there exists a state of 
torpor of the ovaries, as well as of the intestinal canal. These condi- 
tions existing, the combined pill of aloes and asafoetida is indicated 
whether hysteria be present or not. 

The chronic scaly eruptions, chronic eczema, etc., especially when 
the skin is dry and harsh, are much improved by the persistent use of 
asafoetida. 

Bronchorrhwa, bronchitis after the acute symptoms have subsided, 
the cough mamtained by habit which may succeed the whooping-cough, 
and the sympathetic cough of mothers whose children are experiencing 
whooping-cough, are greatly benefited by asafoetida. I£ Mist, asafoeti- 
dse, | iv ; ammonii muriat., 3 j. M. Sig. : A tablespoonful as neces- 
sary. 

Asafoetida, which was formerly much prescribed in asthma, ivhoop- 
ing-cough, and other neuroses of the respiratory organs, has been sup- 
planted by more efficient remedies. 

The disagreeable odor of asafoetida, which is a bar to its employ- 
ment in many of the diseases to the treatment of which it is very well 
suited, is not an objection to its use in hysteria, hypochondriasis, and 
epilepsy. The moral effect of its repulsive odor is not without influence 
in the psychic realm. But the effect of asafoetida is not simply on the 
imagination of the patient ; it has constituents of very positive quality, 
which impress the brain. Hence the utility of asafoetida to arrest the 
hysterical paroxysm, and to relieve the numerous maladies in which 
the hysterical constitution disports itself. The remarks already made 
in regard to the action of asafoetida on the digestive functions in hypo- 
chondriacal subjects, render it unnecessary to speak more at length on 
the use of this remedy in hypochoyidriasis. Asafoetida is no longer 
employed in the treatment of epilepsy, except in the so-called hystero- 
epilepsy. The convulsions of childhood, from reflex irritation, are 
sometimes relieved by this remedy, but it is entirely without utility in 
convulsions arising from renal or cerebral disease. 

Ammoniacum. — Ammoniac. A gum-resin obtained from Dorema 
Ammoniacum Don (Nat. Ord. TJmbelliferw, Orthospermaz) (U. S. P.). 
Gomme ammoniaque, Fr. ; Ammoniakgummi, Ger. 

Emplastrum Ammoniaci. — Ammoniac-plaster. 

Emplastrum Ammoniaci cum Hydrargyro. — (Ammoniac, mercury, 
diluted acetic acid, and lead-plaster.) 

Mistura Ammoniaci. — Ammoniac-mixture. (The resin is sus- 
pended by the gum in water.) Dose, f ss — § j. 

Composition.— Ammoniac contains a volatile oil, which differs from 
the asafoetida oil in not containing sulphur. It has the odor of the 
drug. Ammoniac also contains gum and resin, the latter in the pro- 
portion of about seventy per cent. 



VALERIAN. 461 

Antagonists, Ixcompatibles, and Synekgists, same as for asa- 
foetida. 

Physiological Actions. — The effects of ammoniac are similar to 
those of asafoetida, but it is much less active, owing to the fact, chiefly, 
that its volatile oil does not contain sulphur and phosphorus com- 
pounds. 

Therapy. — Ammoniac may be used for the same purposes as asa- 
foetida, but it is much less efficient than the latter. At present its use is 
almost entirely restricted to chronic bronchial affections, in which the 
mistura is prescribed usually with the carbonate or chloride of ammo- 
nium. Ammoniac-plaster is sometimes used as a discutient to indo- 
lent glandular and inflammatory swellings. 

Authorities referred to : 

Fluckiger and Hanbury. Pharmacographia. 

Gubler, Dr. A. Commentaires Therapeutiques. 

Husemann, Dr. Theod. Handbuch, etc., zweiter Band, p. 987. 

Kohler, Dr. Hermann. Handbuch, etc., erste Halfte, p. 392. 

Stille, Dr. Alfred. Therapeutics and Materia Medica, fourth edition. 

Trousseau et Pidoux. Traite Therap. et Mat. Med., vol. ii. 

Valeriana. — Valerian. The rhizoma and rootlets of Valeriana offi- 
cinalis Linne (Nat. Ord. Valerianaceae). (U. S. P.) Valeriane, Fr. ; 
Baldrianwurzel, Ger. 

Abstractum Valerianae. — Abstract of valerian. Dose, gr. v — 3j. 

Extractum Valerianae Fluidum. — Fluid extract of valerian. Dose, 
3 ss— 1 ss. 

Tinctura Valerianae. — Tincture of valerian (20 parts to 100). Dose, 
3 ss— 3 ij. 

Tinctura Valerianae Ammoniata. — Ammoniated tincture of vale- 
rian (20 parts to 100 spts. ammon. aromat.). 

Ammonii Valerianas. — Valerianate of ammonia. Is a white salt, 
in the form of quadrangular plates, having the disagreeable odor of 
valerianic acid, and a sharp, sweetish taste. It deliquesces in a moist 
air, but effloresces in a dry one, and is very soluble in water and in 
alcohol. It is decomposed by potassa, with evolution of ammonia, and 
by the mineral acids with separation of valerianic acid, which rises to 
the surface in the form of oil. 

Oleum Valerianae. — Oil of valerian. Dose, tt|, ij — tti iv. 

Composition. — Valerian contains from one to two per cent of an 
essential oil, which, if distilled from the perfectly fresh plant, has but 
little odor. In the process of drying of the root, or on exposure to the 
air of the oil distilled from fresh roots, valerianic acid is formed. 
As obtained from the dried root, the oil of valerian consists of valeri- 
anic acid, a camphor, valerene, and valerol. 

An acid strongly resembling valerianic is obtained by the oxida- 



462 CEREBRAL EXCITANTS. 

tion of amylic alcohol ; but the two acids are not identical. The 
valerianic acid of pharmacy is, however, obtained in this way, and the 
various valerianates are products of the combination of the acid formed 
from amylic alcohol with bases. 

Antagonists and Incompatibles. — Quinine, digitalis, ergot, and 
remedies acting similarly, antagonize the actions of valerian. 

Synergists. — All the agents of this group, opium, alcohol, ether, 
etc., increase the action of valerian. 

Physiological Actions. — Valerian and its preparations have a 
hot, pungent taste, and a peculiar and disagreeable odor. A sensation 
of warmth at the epigastrium follows when it is taken into the stom- 
ach. In large doses, nausea, hiccough, eructations of the drug, vomit- 
ing, and diarrhoea, may be produced. In small doses no appreciable 
physiological effects are observed ; but in considerable doses the action 
of the heart is increased, the temperature of the surface rises, and dia- 
phoresis occurs. As respects the nervous system, headache, vertigo, 
exhilaration of mind, spectral illusions, hallucinations, have, it is said, 
been produced by valerian ; but these results are by no means constant 
phenomena. According to Von Grisar (Kohler), oil of valerian re- 
duces the reflex excitability, motility, and sensibility, and antagonizes 
the tetanizing action of brucine. 

The odorous principle — valerianic acid — appears in the sweat, 
breath, and also the urine. 

Therapy. — The flatulence of the hysterical and hypochondriacal 
is quickly relieved by the tincture or fluid extract of valerian. 

It sometimes happens that a mild attack of spasmodic asthma may 
be relieved by valerian, but this by no means efficient remedy quickly 
loses its effect. Whooping-cough, laryngismus stridulus, and other 
neuroses of the respiratory organs, may be occasionally modified by 
this agent ; but it is by no means equal to many other remedies now 
available. 

The chief therapeutic use of valerian is in the treatment of nerv- 
ousness, hysteria, and hysterical disorders generally. There can be no 
difference of opinion as to its great value in these cases ; but as re- 
spects epilepsy, chorea, paralysis agitans, etc., in which it was for- 
merly used, it must suffice to say that it is now never prescribed. 

XJnder the impression that the physiological and therapeutical ac- 
tivity of valerian depends on valerianic acid, various valerianates have 
been introduced into practice. The only one which requires notice 
here is the valerianate of ammonia, which in the form of elixir is fre- 
quently prescribed in hysterical affections. Fluid extract of valerian 
has been used with advantage in diabetes insipidus and also in saccha- 
rine diabetes, but the results are not permanent. It diminishes the 
amount of urinary water in both, and lessens the excretion of sugar in 
the latter, but these effects continue only while the remedy is given. 



CANNABIS INDICA. 463 

Authorities referred to : 
Fluckiger and Hanbury. Pharmacographia. 

Husemann, Dr. Theodor. Handbuch der gcsammten Arzneimittellehre, zweiter Band. 
Husemann, Drs. Aug. und Theo. Die Pflanzenstoffe. 

Kohler, Dr. Hermann. Handbuch der physiologischen Thei-apeutik, etc., erste Halfte. 
Trousseau et Pidoux. Traite de Therapeutique et de Mat. Med., huitieme edition. 

Cannabis Indica. — Indian cannabis. The flowering tops of the 
female plant of Cannabis sativa Linne* (Nat. Ord. TJrticaceoe, Canna- 
binece), grown in the East Indies. (U. S. P.) Chanvre Indien, Fr. ; 
Man/kraut, Ger. 

Cannabis Americana. — American hemp. 

Preparations. — Extractum Cannabis Indicoe. — Extract of canna- 
bis Indica. Dose, gr. \ — gr. ij or more. 

Extractum Cannabis Indicm Fluidum. — Extract of cannabis In- 
dica. Dose, iu ij — 3 ss. 

Tinctura Cannabis Indicm. — Tincture of cannabis Indica. Dose, 
m v— 3 j. 

Composition. — The physiological activity of hemp is influenced 
largely by soil and climate ; for, although in botanical characters In- 
dian and American hemp are identical, the Indian hemp possesses de-' 
cidedly more narcotic power. Indeed, until recently, it was supposed 
that American hemp was devoid of the peculiar properties possessed 
by the Indian ; but it has been shown that American hemp does really 
have effects similar in kind to, but much less in degree than, those 
caused by the Indian. 

The most important constituent of hemp is a peculiar resin, canna- 
bin, which possesses the active powers of the plant. By distillation 
of the leaves and stems, a peculiar volatile oil is obtained ; and this is 
divisible into cannabene, a very light hydrocarbon, and hydride of 
cannabene, a solid crystalline substance. 

An impure resin, collected in an imperfect and crude way from the 
leaves and stems, is known as charas, or churrus. Bhang consists of 
the dried leaves and stalks made into a confection with preserved fruits 
and aromatics, and, in this form, constitutes the well-known hashish. 
Gunjah is the female flowering plant, dried, from which the resin has 
not been extracted. 

No arbitrary rules for the dose can be laid down. In beginning 
the use of any newly-made preparation, it is safer to commence with 
the minimum dose. Having, by gradually increasing the quantity, 
ascertained the physiological activity of that particular specimen, it 
may then be pushed according to the necessities of the case. 

Antagonists and Incompatibles. — The caustic alkalies, the acids, 
strychnine, and induction electricity, oppose the actions of hemp. In 
cases of poisoning, the stomach should be evacuated, and symptoms be 
combated as they arise. Strychnine may be injected hypodermatical- 



464 CEREBRAL EXCITANTS. 

ly, and the respiration be maintained by faradization of the respiratory 
muscles. As, however, hemp possesses but feeble toxic power, cases 
of acute poisoning have never been reported. 

Synergists. — Alcohol, ether, nitrous oxide, the mydriatics — bella- 
donna, hyoscyamus, etc. — opium, and the cerebral stimulants general- 
ly, promote the actions of hemp. 

Physiological Actions. — The resin of hemp is a soft solid ; is 
soluble in alcohol and in ether, in the fixed and volatile oils, and in 
the fats. It has a balsamic taste, but is bitter and acrid. It promotes 
the appetite and the digestion somewhat. The most important actions 
are those referable to the nervous system. There is a distinction to 
be made between the effects on the nervous system of the inhalation 
of the fumes of hashish and those effects which follow the stomach 
administration. Inattention to this point has, probably, given rise to 
most of the confusion regarding the physiological actions of this rem- 
edy. When inhaled it produces a singular muscular erythism and agi- 
tation, a great desire for muscular activity and motion, an entire absence 
of the sense of fatigue ; but these sensations are followed by exhaus- 
tion, even by syncope. Hallucinations occur, but they are not usually 
agreeable ; they are often painful, and are replaced by stupor. 

By the stomach, and in moderate doses, hashish is an excitant of 
the nervous system, increasing intellectual and motor activity. In 
large doses, it lowers the tactile sense and the sense of pain — in other 
words, it is analgesic and anaesthetic — and it induces a cataleptic state, 
in which the muscles maintain any position in which they may be 
placed. The mental intoxication is ordinarily of an agreeable kind ; 
the ideas flow more easily, are highly pleasurable, and are usually ac- 
companied by bursts of gay laughter. Not unfrequently the excite- 
ment takes the form of a furious delirium, in which acts of violence 
are committed — whence the name " haschaschins," or assassins, applied 
to the unfortunate hashish-eater who, under the influence of the drug, 
commits murder. It has been maintained, and probably rightly enough, 
that the form which the delirium takes represents the mental and moral 
condition of the individual in his normal state : those who are amiable 
and gay become more so under the influence of hashish ; and those 
possessed of evil and malignant dispositions enact deeds of violence. 

Under the influence of hashish the knowledge of time is lost ; such 
are the number and variety of the images which occupy the mind, 
that a few minutes appear to be hours, days, or even years. After the 
effects of the drug have passed off, the hashish-eater is usually uncon- 
scious of the events that have transpired. Sleep or coma, according 
to the dose, ends the effects of the drug. 

Dilatation of the pupil, and disorders of vision, which contribute to 
the hallucinations by the distortion of external objects, are produced 
by hemp. Aphrodisiac effects are said to follow the use of hashish ; 



CANNABIS INDICA. 465 

but impotence, which is common in hashish-eaters, doubtless results 
from the repeated over-stimulation of the sexual organs. 

It is not known by what organs, or in what form, hashish is elimi- 
nated. The effects of a large dose are not entirely expended in twenty- 
four hours, and those who have taken it by way of experiment have 
suffered vertigo, headache, and other cerebral symptoms, for some time 
subsequently. It does not increase any of the secretions, except it may 
be the urinary, somewhat ; and it does not stimulate into increased 
activity any organs except the cerebro-spinal and the sexual. The 
sleep or stupor which it produces, and which comes on after the stage 
of excitement, is not followed by after nausea and depression, as in the 
case of opium. 

Therapy. — The extract of cannabis Indica enters into the compo- 
sition of chlorodyne, a nostrum which has had a great reputation as an 
anodyne and hypnotic. In cholera morbus and diarrhoea this remedy 
has been used successfully, but we now possess more efficient ones. 

Before the days of anaesthesia, and in very remote times, the fumes 
of hashish were employed to stupefy and to render painless surgical 
operations. It was also employed to relieve pain, and as a substitute 
for opium in neuralgia, and as an hypnotic. In migraine it has been 
used with decided success by Seguin, Williams, and others. Good re- 
sults have been obtained from it in epilepsy by Sinkler and others, and 
it deserves further consideration in this disease. In chorea, and in 
delirium tremens, it is strongly urged by De Cavaillon, and in senile 
trembling and paralysis agitans it has afforded relief. About one half 
of the cases of tetanus, for which hemp was much prescribed a few 
years ago, got well under its use ; but more accurate knowledge of 
the natural history of this disease has shown that many cases tend to 
recovery without the aid of medicines. 

It is well established that hemp has the power to promote uterine 
contractions. It can not initiate them, but increases their energy when 
action has begun. It may be given with ergot. In consequence of 
this power which it possesses to affect the muscular tissue of organic 
life, hemp is used successfully in the treatment of menorrhagia. It is 
said to be especially useful in that form of menorrhagia which occurs 
at the climacteric period (Churchill). It has, more recently, been shown 
to possess the power to arrest hemorrhage from any point, but it is 
chiefly in menorrhagia that so much good is accomplished. 

There can be no doubt that cannabis Indica is a useful remedy in 
cases of impotence. It need hardly be stated that it is adapted to the 
functional disorder. It may be advantageously combined with ergot 
and nux vomica in this malady ; for example : fy Ext. cannabis Indi- 
cse, gr. x ; ergotin (aq. ex.), 3ij ; ext. nucis vom., gr. x. M. Ft. pil. 
no. xx. Sig. : One morning and evening. 

This agent has also been used with success in the treatment of 

30 



466 CEREBRAL EXCITANTS. 

gonorrhoea. It diminishes the local inflammation, allays chordee, and 
lessens the pain and irritation, with the accompanying restlessness. 

Authorities referred to : 

Bulletin General de Therapeutique. Various articles, 1870, "74, "76. 
Fluckiger and H anbury. Pharmacographia, p. 491. 
Seguin, Dr. E. C. New York Medical Record, vol. xii, p. 7*74. 
Williams, Dr. S. W. London Medical Record, vol. i, p. 407. 

Erythroxylon. — Coca or cuca. The leaves of Erythroxylon coca 
Lamarck (Nat. Ord. JErythroxylacem). (IT. S. P.) 

Preparation. — Extr actum Erythroxyli Fluidum. — Fluid extract 
of erythroxylon. Dose, 3 ss — 3 ij. 

Composition. — The effects of coca, or cuca, depend on the pres- 
ence of a peculiar alkaloid — cocaine. It contains also an aromatic oil 
which gives it the special aroma and taste, and it possesses consider- 
able astringency, due to the presence of a tannic acid. The odor, 
taste, and appearance of the infusion are comparable to those of tea. 
Cocaine has decided basic properties, and combines with acids to form 
salts. It crystallizes in prisms in the smaller rhombic system (Huse- 
mann), which, when pure, are transparent and colorless. It is very 
slightly soluble in water and in alcohol, but dissolves freely in ether. 
It has a bitter taste, and the salts are more bitter than the alkaloid 
itself. 

Antagonists and Incompatibles. — The actions of coca are op- 
posed by all those agents which increase waste. The infusion and 
fluid extract are incompatible with the metallic salts. Muriatic acid 
splits cocaine into benzoic acid and an alkaloid — ecgonine ; hence the 
mineral acids should not be prescribed with the infusion and fluid ex- 
tract. 

Synergists. — The agents promoting constructive metamorphosis, 
caffeine, the cerebral stimulants, and the narcotics generally, increase 
the effects of coca. 

Physiological Actions. — The historical notes of Sir R. Christi- 
son show that the peculiar properties of cuca-leaves have long been 
known to the inhabitants of Peru. The leaves have a strong, tea-like 
odor, and the infusion resembles ordinary tea in taste. The volatile 
oil and the active principle are readily diffusible, and enter the blood 
with facility. A momentary depression of the pulse and diminution 
of the blood-pressure take place, but these effects are quickly over- 
come, and a considerable increase in the action of the heart and of the 
blood-pressure follows (Ott). A feeling of contentment and of well- 
being takes possession of the mind, the sense of fatigue is removed, 
drowsiness is experienced for a brief period, but it is soon succeeded 
by wakefulness, and increased mental activity. It has long been 
known to the mountaineers of the Peruvian Andes that chewing cuca- 



CAFFEIXE. 467 

leaves increases the respiratory power, and removes, or lessens, the 
sense of fatigue. The celebrated pedestrian, Weston, having learned 
this fact, was detected in the use of cuca during one of his extraordi- 
nary feats in London (Thompson). 

As respects the action of cocaine on the nervous system, it has been 
demonstrated that it diminishes the excitability of the motor nerves, 
and impairs the power of voluntary co-ordination. Its influence on the 
sensory nerves depends on the quantity of the drug ingested ; a small 
quantity increases the excitability of the sensory nerves, whereas a 
large quantity causes paralysis (Ott). It is not known whether or not 
the paralysis is the result of over-stimulation and an exhaustion of 
the sensibility. The posterior columns of the spinal cord are chiefly 
affected. The paralysis of the heart which ensues from a large quan- 
tity seems to be due to an action on the intra-muscular ganglia of this 
organ. It first excites, then paralyzes, the respiratory center. 

The most interesting question connected with the action of cuca is 
its influence over the metamorphosis of tissue. It certainly lessens 
urea-elimination. As is the case with coffee and tea, cuca acts as an 
indirect nutrient, by checking waste, and hence a less amount of food 
is found necessary to maintain the bodily functions. It is probable 
that some of the constituents of cuca are utilized in the economy as 
food, and that the retardation of tissue-waste is not the sole reason 
why work may be done by its use which can not be done by the same 
person without it. 

Therapy. — Although cuca possesses valuable powers as a restora- 
tive, but little use has been made of it, except by the French. It will, 
no doubt, be found useful in phthisis, and wasting diseases generally, 
and in convalescence from acute maladies. It is a valuable remedy in 
the nervous form of sick-headache, migraine. It has been used with 
distinct advantage in the depression caused by the withdrawal of 
opium, in the treatment of the opium-habit, and in functional impo- 
tence, due to a lowered condition of the general health. 

Authorities referred to : 

Bouchardat, Prof. Annuaire de Therapeutique, 1876. 

Christison, Sir Robert. The British Medical Journal, April 29, 1876. 

Husemann, Drs. August und Theodor. Die Pflanzenstoffe, p. 89. 

Ott, Dr. Isaac. Cocaine, Veratria, and Gelsemia. Philadelphia : Lindsay & Blakis- 
ton, 1874. 

Thompson, Mr. J. Ashburton. The British Medical Journal, March 11, 1876, and 
March 18, 1876. 

Caffeilia. — Caffeine. A proximate principle of feebly alkaloidal 
power, generally prepared from the dried leaves of Camellia thea Link 
(Nat. Ord. TemstrcemiacecB), or from the dried seeds of Caffea Arabica 
Linne (Nat. Ord. Hubiacem), or from guarana, and occurring also in 
other plants. (U. S. P.) 



468 CEREBRAL EXCITANTS. 

Preparations. — Citrate of caffeine. Dose, gr. j — grs. v. 

Properties. — Caffeine crystallizes in needle-shaped crystals, and 
in prisms, the form depending on the mode of evaporating a concen- 
trated solution. It has a bitter and disagreeable taste, and is soluble 
in water, alcohol, and ether. As regards composition, caffeine is re- 
markable for the quantity of nitrogen which it contains, surpassing in 
this respect almost all the alkaloids. In the coffee-bean, caffeine ex- 
ists in combination with a peculiar acid, caffeic, and with caffeo-tannic 
acid. 

Antagonists and Incompatibles. — Tannic acid, iodide of potas- 
sium, and the salts of mercury, precipitate caffeine from its solution 
in water. Physiologically, it is antagonized by opium (Bennett). 

Synergists. — The actions of caffeine are promoted by the agents 
of this group, and by the mydriatics. 

Physiological Actions. — -The effects of coffee as a beverage have 
been sufficiently discussed elsewhere. 

Caffeine, in small medicinal doses, promotes appetite, increases the 
digestive power by stimulation of the gastric glands, and relaxes the 
bowels slightly. On the heart it exerts at first a decided stimulant 
action, and raises the arterial tension ; but these effects are succeeded 
by weakened cardiac movements and diminished blood-pressure, the 
cardiac muscle and its contained ganglia being both probably para- 
lyzed by it. Respiration ceases before the heart stops in animals poi- 
soned by caffeine (Bennett). 

As regards the cerebral effects, it may be stated that, at first, 
drowsiness occurs ; but this is soon followed by wakefulness, excite- 
ment, muscular trembling, confusion of mind, hallucinations, and 
delirium. The cerebral effects terminate in deep sopor, but this is 
probably the result of exhaustion. Rise of temperature, convulsions, 
general paralysis, occur when toxic doses are administered to animals ; 
but the temperature declines when paralysis supervenes (Leven, 
Schmiedeberg, Bennett, and others). 

Therapy. — Caffeine is a useful stomachic tonic. In convalescence 
from acute maladies, it is in a high degree serviceable, given to pro- 
mote the constructive metamorphosis. Chronic catarrh of the stomach, 
with occasional attacks of migraine, is a combination of maladies in 
which caffeine is especially useful. Paullinia, or cuca, may be used 
instead. 

In the diarrhoea of phthisis, in ordinary atonic diarrhoea, in cholera 
infantum, and in cholera morbus, produced by agencies affecting the 
nervous system, the remedies of this group, especially caffeine, are 
often extremely useful. When the vital powers are depressed, and 
when there is at the same time an abnormal excretion of urea — a 
condition of things which exists in incipient phthisis, associated with 
indigestion — caffeine, cuca, and paullinia are in a high degree service- 



GUARANA. 469 

able. They increase the appetite and the digestive power, and dimin- 
ish tissue-waste. 

Black coffee, or caffeine, increases the action of the heart and raises 
the arterial tension, and is therefore useful when the circulation is de- 
pressed from various causes. 

An important use of caffeine, at present, is in the treatment of 
headache. It is adapted especially to the relief of migraine, the 
so-called nervous headache, accompanied with or without stomach- 
derangement. In this disorder we may administer a grain of caffeine 
every half -hour, until the headache is relieved ; or the citrate of caf- 
feine may be given in an effervescent draught. A very elegant prep- 
aration is the granular, effervescent citrate of caffeine. 

Caffeine has proved very useful in cardiac dropsy / and in renal 
dropsy in inverse ratio to the amount of damage suffered by the kid- 
neys, for, as Brackenridge has shown, this remedy does not increase 
the flow of urine when the renal epithelium is destroyed. It may be 
used with advantage in ascites when any diuretic will prove service- 
able. It has, within the past two years, been much employed by the 
French therapeutists, in place of digitalis, in the treatment of certain 
cardiac affections. According to Huchard, caffeine acts more rapidly 
than digitalis, causing free diuresis in twenty-four hours. It slows 
the pulse and raises the arterial tension, thus effecting a better distri- 
bution of the blood. To bring about these desirable effects, Huchard 
rapidly increases the dose, so that on the third day he gives a gramme 
(15 J grs.) hypodermatically. 

The action of opium is antagonized by caffeine ; hence this agent 
is employed in opium narcosis, and in some cases with success. It 
may be injected hypodermatically when the patient is unable to swal- 
low ; but it can not take the place of atropine. 

In hypochondriasis, and in simple melancholy, caffeine has been 
used with advantage. It may be given to relieve the drowsiness which 
in so many persons comes on after a late dinner. It helps to dissipate 
the stupor of urcemia. 

Cases of cervico-brachial neuralgia have been relieved by the hypo- 
dermatic injection of caffeine. 

Guarana. — A dried paste, prepared from the crushed or ground 
seeds of Paullinia sorbilis Martius (Nat. Ord. Sapindacece). (U. S. P.) 

Extr actum Guaranm Fluidum. — Fluid extract of guarana. Dose, 
m x— 3 ij. 

Composition. — It contains a principle which has been entitled gua- 
ranine, and which subsequent researches have proved to be identical 
with caffeine. 

Actions and Uses. — The physiological effects of paullinia are due 
to its alkaloid, chiefly ; and, as this is the same as caffeine, the ob- 



470 CEREBRAL SEDATIVES. 

servations already made on the latter are equally applicable to the 
former. 

The special use of paullinia is in the treatment of sick-headache 
or migraine. It is adapted to the so-called nervous form of sick- 
headache, and is less efficient when the attacks are due to stomachal 
troubles. As it possesses, directly or indirectly, restorative powers, it 
may be employed to promote constructive metamorphosis. Adminis- 
tered with this view, it may be given with advantage in the conva- 
lescence from acute maladies, in incipient phthisis, and in the wasting 
diseases generally. 

The most agreeable form in which to administer paullinia is the 
elixir, but, as this preparation varies according to the taste, honesty, 
and skill of the apothecary, the physician needs to be assured of its 
quality before prescribing. 

Authorities referred to : 

Amory, Dr. R. Boston Medical and Surgial Journal, 1868, p. 17. 

Aubert, M. Physiological Action of Caffeine. Centralblatt, 1873, p. 124. 

Bennett, Dr. Alexander. Physiological Actions of Theine, Caffeine, Guaranine, 
Cocaine, and Theobromine. Pamphlet, 1873. 

Huchard, Dr. Henri. De la Cafeine dans les Affections du Cotur. Journal de Thera- 
peutic, September 10, 1882. 

Leven, M. Archiv de Physiologie, 1868, pp. 179, 470. 

Pratt, Dr. Boston Medical and Surgical Journal, vol. ii, 1868, p. 6. 

Schmiedeberg, Prof. 0. Ueber die Verschiedenheit der Caffeinwirkung an Rana tern- 
poraria L. und Rana esculenta L. Arch.f exper. Path. u. Phar., 1874, p. 63. 



REMEDIES WHICH DIMINISH OR SUSPEND THE 
FUNCTIONS OF THE CEREBRUM AFTER A PRE- 
LIMINARY STAGE OF EXCITEMENT. 

To this group belong the so-called narcotics, the ansesthetics, and 
some of those usually classed as antispasmodics. They all agree in 
these respects : their effects are expended, chiefly, on the nervous sys- 
tem ; they first stimulate the functions of the brain, but this stage of 
excitement, which may be of shorter or longer duration, is followed by 
sopor, coma, and complete insensibility. 

Alcohol. — Alcohol. A liquid composed of 91 per cent by weight 
(94 per cent by volume) of ethyl alcohol, and 9 per cent by weight (6 
per cent by volume) of water. Specific gravity, 0*820 at 60° Fahr. 
A transparent, colorless, mobile, and volatile liquid of a characteristic, 
pungent, and agreeable odor, and a burning taste. (IT. S. P.) 

Alcohol Dilutum. — Diluted alcohol. A liquid composed of 45*5 
per cent by weight (53 per cent by volume) of ethyl alcohol, and 54*5 
per cent by weight (47 per cent by volume) of water. Specific gravity, 



ALCOHOL. 471 

0-928 at 60° Fahr. Alcohol, 50 parts ; distilled water, 50 parts. 
(IT. S. P.) 

Alcohol Amylicum. — Amylic alcohol. Fusel-oil. 

A peculiar alcohol, obtained from fermented grain or potatoes, 
by continuing the process of distillation after the ordinary spirit has 
ceased to come over. An oily, nearly colorless liquid, having a strong, 
offensive odor, and an acrid, burning taste. Its specific gravity is 
0*818, and its boiling-point between 268° and 272°. It is sparingly 
soluble in water, but unites in all proportions with alcohol and ether. 
It does not take fire by contact with flame, and, when dropped on 
paper, does not leave a permanent greasy stain. Exposed to the air in 
contact with platinum-black, it is slowly oxidized and yields valerianic 
acid. (U. S. P., 1870.) 

Spiritus Frumenti. — Whisky. An alcoholic liquid, obtained by 
the distillation of fermented grain (usually corn, wheat, or rye), and 
at least two years old. 

Whisky has an amber color, a distinctive taste and odor, and a 
specific gravity not above 0*930 nor below 0*917, corresponding ap- 
proximately with an alcoholic strength of 44 to 50 per cent by weight, 
or 50 to 58 per cent by volume. 

Spiritus Vini Gallici. — Brandy. An alcoholic liquid obtained 
by the distillation of fermented grapes, and at least four years old. 

Brandy has a pale, amber color, a distinctive taste and odor, and a 
specific gravity not above 0*941 nor below 0*925, corresponding ap- 
proximately with an alcoholic strength of 39 to 47 per cent by weight, 
or 45 to 55 per cent by volume. (U. S. P.) 

Composition. — A large number of bodies have been classed under 
the generic term of alcohols. A list of the most important of these is 
subjoined : 

Methylic alcohol. CH 4 0. 



Ethylic 

Propylic 

Butylic 

Amylic 

Caproic 



C 2 H 6 or CH 4 + (CH 2 ). 
C 3 H 8 or CH 4 04-2(CH 2 ). 
C 4 H 10 or CH 4 + 3(CH 2 ). 
C 5 H 12 or CH 4 + 4(CH 2 ). 
C 6 H 14 or CH 4 + 5(Cn 2 ). 



These alcohols are called " homologous," because they are closely 
related to each other, and differ by the common multiple CH 2 . Ethylic 
is the common or ordinary alcohol, and amylic is an impurity existing 
in certain alcoholic beverages — for example, whisky, in which it oc- 
curs in consequence of the cupidity of distillers in carrying on the 
process after all the ethylic alcohol has distilled over. Absolute alco- 
hol should be entirely free from any odor except its native ethereal 
odor, and no products but carbonic acid and water should result from 
its combustion. 

Whisky is a solution of alcohol in water (48 to 56 per cent), but 



472 CEREBRAL SEDATIVES. 

contains various odorous principles and ethers which impart to it its 
peculiar physical properties. The best specimens, doubtless, contain 
traces of f usel-oil, and acetic, butyric, and sometimes valerianic acids 
are present in it. The reactions of these acids with the alcohol result 
in the formation of various ethers, and hence old whisky is more fra- 
grant, and therefore more highly prized, than the recent product of 
the still. 

Brandy is also a solution of alcohol in water (48 to 56 per cent). 
It has a wine-like odor, and a hot, astringent taste. It contains a 
volatile oil, an ether peculiar to wines (cenanthic ether), coloring-mat- 
ters, tannic acid, aldehyde, and acetic ether. The color is usually fac- 
titious : in pale brandy, the color is derived from the cask ; in dark 
brandy, from caramel. Brandy is made artificially from high-wines 
by the addition of an ether (cognac, acetic or nitric), of coloring- 
matter (burnt sugar), and an astringent to give it the necessary rough- 
ness of taste (logwood, catechu, etc.). 

Physiological Actions. — Alcohol in prolonged contact with the 
skin, evaporation being prevented, excites a sense of heat and super- 
ficial inflammation. It coagulates albumen and hardens the animal 
textures. The epithelium of the mouth is corrugated by it — a result 
due to the abstraction of water and condensation of the albumen. In 
the stomach alcohol causes a sense of warmth, which diffuses over the 
abdomen, and is quickly followed by a general glow of the body. In 
moderate quantity it induces a superficial congestion of the mucous 
membrane — a dilatation of the arterioles — and this increased blood- 
supply enables the mucous follicles and the gastric glands to produce 
a more abundant secretion. The increased formation of the stomach- 
juices is doubtless somewhat determined by the stimulation of the 
mouths of the glands, in accordance with a well-known physiological 
law. The excitation of the gastric mucous membrane, when habitual, 
results in important changes ; a gastric catarrh is established — for the 
mucous follicles, under the influence of repeated stimulation, pour 
forth a pathological secretion. The gastric glands at first simply pro- 
duce an increased amount of gastric juice, but abnormal stimulation 
results in pathological changes in this secretion. The increased blood- 
supply to the mucous membrane sets up an irritation of the connective 
tissue, which undergoes hyperplasia ; the proper secreting structure 
is encroached upon, and the glands suffer atrophic changes which re- 
sult in still more important modifications of the gastric juice. Alco- 
hol also affects directly the constitution of the gastric juice by precipi- 
tating the pepsin from its solution and by arresting the activity of this 
ferment. 

In small doses, not too frequently repeated, alcohol increases the 
digestive power by stimulating the flow of blood and soliciting a 
greater supply of the stomach-juices. Large doses impair digestion 



ALCOHOL. 473 

directly by precipitating the pepsin, an albuminoid ferment. That a 
small quantity does not produce the same results in a comparative de- 
gree, is simply due to the fact that it is too far diluted, by the quan- 
tity of fluid present in the stomach, to act on the pepsin. 

The structural alterations induced by the habitual use of alcohol, 
and the action of this agent on the pepsin, seriously impair the diges- 
tive power. Hence it is that those who are habitual consumers of 
alcoholic fluids suffer from disorders of digestion — gastric catarrh. The 
abnormal mucus which is elaborated in great quantity, acts the part of 
a ferment, and the starchy, saccharine, and fatty elements of the food 
undergo the acetic, lactic, and butyric fermentations. Acidity, heart- 
burn, pyrosis, regurgitation of food, and a peculiar retching in the 
morning (morning vomiting of drunkards), are produced. 

As alcohol is a very diffusible substance, it enters the blood with 
great facility, and probably almost all of that taken into the stomach 
passes into the blood from this organ, and does not reach the small 
intestine. The liver is consequently the first organ, after the stomach, 
to be influenced by the ingested alcohol. The blood of the portal 
vein, rendered more highly stimulating by the presence of alcohol, in- 
creases for the time being the functional activity of the liver-cells, 
and, as is the case with the stomach, a more abundant glandular secre- 
tion follows. Frequent stimulation and consequent over-action result 
in impairment or loss of the proper function of the part, as is the uni- 
versal law. The hepatic cells, over-stimulated, produce an imperfect 
product ; they are affected by fatty and atrophic changes, and shrink 
in size ; and the connective tissue of the liver undergoes hyperplasia. 
The first result of the structural alterations is an increase in the size 
of the organ ; but with the shrinking of the hepatic cells, and the con- 
traction of the newly-formed connective tissue, the liver becomes 
smaller, nodulated, and hardened. To this change the term cirrhosis 
has been applied. It is essentially a slowly-developing and chronic 
malady, and long indulgence in alcoholic liquids is necessary to its pro- 
duction. 

In small doses, alcohol increases the action of the heart and the 
cutaneous circulation ; a slight general rise of temperature is observed ; 
and all of the functions are, for the time being, more energetically 
performed. If a considerable dose be taken, the phenomena of exhila- 
ration, of excitement, of slight intoxication ensue. A still larger quan- 
tity causes loss of muscular power, impaired co-ordination of voluntary 
movements, and rambling incoherence. When a toxic dose is taken, the 
stage of excitement is of short duration ; profound insensibility, with 
stertorous breathing and complete muscular resolution, quickly follow. 

As respects the action of alcohol on the nervous system, it is ob- 
vious that its first effect is to increase the functional activity of the 
brain ; the ideas flow more easily, the senses are more acute, the muscu- 



474 CEREBRAL SEDATIVES. 

lar movements are more active. These effects are coincident with the 
increased action of the heart, the slight rise of temperature, and the 
greater activity of the functions of the organism in general. With 
the increased action of the alcohol on the cerebrum the excitement 
becomes disorderly, the ideas incoherent and rambling, the muscular 
movements uncontrolled and inco-ordinate (over-stimulation of the 
cells of the gray matter). With an excessive quantity, the functions 
of the cerebrum are suspended, and complete unconsciousness ensues ; 
the reflex movements cease ; the functions of organic life are performed 
feebly ; and, by an extension of the toxic influence to the centers pre- 
siding over these movements, respiration and circulation are finally 
arrested. 

That these effects on the intra-cranial organs are due to the direct 
action of the alcohol has been shown. Alcohol has been discovered in 
the fluid contained in the ventricles, and has been distilled from the 
cerebral matter ; and Hammond has demonstrated that it has a special 
affinity for nervous matter, being found in the cerebro-spinal axis and 
in the nerves, in greater quantity than in other tissues of the body. 
As a result of the direct contact, chiefly, but in part also from the va- 
riations in the intra-cranial blood-current, important structural altera- 
tions are gradually wrought in the cerebral matter. The cells of the 
gray matter become more or less fatty and shrunken, the neuroglia 
undergoes hyperplasia, shrinking and condensation of the whole cere- 
brum ensue (sclerosis), and the cerebro-spinal fluid relatively increases. 
The objective evidences of these pathological changes are seen in the 
impaired mental power, the muscular trembling, the shambling gait, of 
the drunkard. 

In some subjects from sudden excess of a periodical kind, in others 
from a failure of the stomach to dispose, not only of aliment, but of 
the accustomed stimulus, a peculiar morbid state, known as delirium 
tremens, is produced. Peculiarity of the nervous system — idiosyncra- 
sy — is an important factor in the causation of this condition, and 
probably also the use of alcoholic beverages rich in fusel-oil — for Rich- 
ardson has shown, and the author has repeatedly confirmed the obser- 
vation, that amylic alcohol causes tremors and muscular twitching 
" identical with the tremors observed in the human subject during the 
alcoholic disease known as delirium tremens." 

The long-continued action of alcohol on the nervous system pro- 
duces other disorders besides delirium tremens. Hemi-anaesthesia, 
epilepsy, paraplegia, amaurosis, etc., have been observed to result from 
alcoholic excess, and mental alienation, as the asylum statistics prove, 
lias in the same agent its most influential cause. 

It is necessary now to consider what becomes of the alcohol after 
its introduction into the human body, and the influence which it exerts, 
if any, in the metamorphosis of tissue. The results of experiment on 



ALCOHOL. 475 

these points have been remarkably contradictory ; and the questions 
involved are by no means settled. It would require a volume to make 
a satisfactory analysis of the various memoirs and papers which have 
been published on the actions of alcohol. The author, therefore, 
merely presents the conclusions to which he himself has come, after a 
careful consideration of all the more important contributions to the 
literature of the subject. 

A small quantity of alcohol, in a subject not accustomed to its use, 
causes, as has been already stated, increased activity in all the bodily 
functions, and slight elevation of temperature. Habit, as is the case 
with a great many drugs, modifies in a remarkable manner the physio- 
logical activity of alcohol, and hence these results are not perceived in 
the habitual consumers of this substance. Considerable doses of alco- 
hol cause a decline in the temperature of the body, which is even more 
marked in pyrexia than in the normal state. As respects this effect, 
the influence of habit is equally great, for in old topers a decline in 
temperature does not follow the use of alcohol in doses short of lethal. 
In animals the reduction of the body-heat is more marked than in 
man. To what cause is the decline in temperature, produced by alco- 
hol, attributable ? This is, doubtless, referable to the diminished rate 
of tissue metamorphosis — for it has been ascertained that the excretion 
both of urea and of carbonic acid is lessened by alcohol. The combus- 
tion of the nitrogen and carbon foods is, therefore, retarded. This 
action is represented, objectively, by an increase in the body- weight 
and the embonpoint of those who take stimulants moderately. 

The disposition of alcohol in the organism is a subject which has 
gone through several revolutions of opinion. At present the weight of 
authority and the deductions of experiment are in favor of that view 
which maintains that, within certain limits (one ounce to one and a 
half ounce of absolute alcohol to a healthy man), alcohol is oxidized 
and destroyed in the organism, and yields up force which is applied as 
nervous, muscular, and gland force. The amount of alcohol ingested, 
in excess of this oxidizing power of the organism, is eliminated as alco- 
hql by the various channels of excretion — by the lungs, skin, kidneys, 
etc. As alcohol checks tissue metamorphosis, and thus diminishes the 
evolution of heat and force, it might be expected that the products of 
its own oxidation would supply the deficiency, but this is not the case. 
Alcohol is a useful food in the small quantity which increases but 
does not impair digestion, which quickens the circulation and gland 
secretion but does not over-stimulate, and which is within the limit of 
the power of the organism to dispose of by the oxidation processes. 
This amount has been pretty accurately shown, as stated above, to be 
one ounce to one ounce and a half of absolute alcohol for a healthy 
adult in twenty -four hours. All excess is injurious. North -pole 
voyages, military expeditions (experiences in India and the Ashantee 



476 CEREBRAL SEDATIVES. 

march), and the diminished power of resistance to cold shown by- 
drunkards, have conclusively demonstrated that alcohol does not sup- 
ply the place of other foods ; and that those habituated to its use, 
damaged as they are in their vital organs, do not possess the same 
endurance of fatigue and the same power of resistance to external 
morbific influences as do the healthy. Furthermore, clinical expe- 
rience has amply proved that topers do not bear chloroform well, that 
they succumb more quickly to injuries and surgical operations, and 
that they possess much less power of resistance than the temperate to 
the inroads of acute diseases. While these facts rest upon the soundest 
basis, it is equally true that alcohol is, within certain limits, a food, and 
that the organism may subsist, for a variable period, on it exclusively. 

It is an important clinical fact that the physiological effects of alco- 
hol differ in different conditions of the system. In convalescence from 
acute diseases, in the sudden depression of the powers of life caused by 
the bites of venomous snakes, or from loss of blood, or from serious 
injury, quantities which would, in the state of health, cause profound 
intoxication, are taken with impunity. The extremes of life — infancy 
and old age — bear considerable quantities of alcohol well, and are often 
remarkably benefited by them. Habitual use modifies still more de- 
cidedly the immediate influence of this agent on the functions of calor- 
ification, of circulation, and of the nervous system. 

The differential diagnosis of acute alcoholism (lethal dose), of opium 
narcosis, concussion of the brain, cerebral haemorrhage, and haemor- 
rhage into the pons or medulla, is by no means easy. In the absence 
of the history, in any given case, it may be impossible to determine. 
The odor of the breath (of opium or alcohol) ; the state of the pupil 
(contracted from opium, unequal, or contracted or dilated from intra- 
cranial haemorrhage, contracted or dilated from alcoholic intoxica- 
tion) ; the muscular resolution (common to all these states) ; the slow, 
sighing, irregular, or stertorous respiration (may occur in either) ; the 
abolition of reflex movements (a final symptom in all), are in the nature 
of things fallacious. A man who has received a concussion of the brain, 
or had an intra-cranial haemorrhage, may have taken opium or alcoholic 
stimulants in quantity sufficient to impart a distinct odor to his breath, 
without otherwise being distinctly affected by it. The other signs are 
not sufficient in themselves to enable a decision to be reached. Hence 
the importance of an attentive examination of the surrounding circum- 
stances. In the absence of a trustworthy history, it were better to 
suspend opinion until the further developments of the case enable an 
exact diagnosis to be made. The numerous examples of errors fallen 
into by most competent observers should make the physician hesitate 
before pronouncing an opinion of " drunk " or " dying," in the sensa- 
tional language by which some of these cases of mistake have been 
characterized. 



ALCOHOL. 477 

The treatment of acute alcoholism consists in the evacuation of 
the stomach by the stomach-pump of any unabsorbed alcohol ; the 
cautious inhalation of ammoniacal gas ; cold affusion to the head ; 
faradism of the muscles of respiration, external warmth, etc. 

As respects the post-mortem appearances the following have been 
observed : intense hyperemia of the gastric mucous membrane ; dis- 
tention of the right cavities of the heart, and of the great venous 
trunks ; hyperemia of the cerebral meninges, and serous effusion into 
the ventricles and subarachnoid spaces. 

Therapy. — Alcohol in small doses is a useful stomachic tonic. It 
is best taken for this purpose after or with meals. It is specially ser- 
viceable in the feeble digestion of old people, the atonic dyspepsia of 
the sedentary, and in the slow and inefficient digestion of convales- 
cence from acute diseases. It should be prescribed with caution in 
these cases, especially in the atonic dyspepsia of women and of seden- 
tary men, because of the danger that an alcohol habit may be formed. 
When it is prescribed in the convalescence of acute diseases, the stimu- 
lant should be withdrawn at the earliest period. 

Excellent results are obtained from the use of brandy in the apep- 
sia of infants. The summer diarrhoea, both of children and adults, 
may be arrested by a full dose of brandy. Irritating matters and un- 
digested food should be removed before the brandy is administered. 
The vomiting of cholera-morbus and of cholera may, frequently, be 
arrested by small doses of iced brandy (a teaspoonful in pounded ice 
every half-hour), or tablespoonful doses of iced champagne. Other 
forms of vomiting, when due to irritation or inflammation of the 
stomach — as, for example, the vomiting of pregnancy — can sometimes 
be promptly cured by the same remedy. It not unfrequently happens 
that, in delirium tremens, nothing is retained by the stomach, and the 
life of the patient is put into imminent danger, by reason of the failure 
of the food-supply to the blood. A little brandy and ice will some- 
times settle the stomach under these circumstances, and enable the 
patient to take and digest the much-needed aliment. 

Notwithstanding the theoretical objections which may be urged 
against this practice, clinical experience is strongly in favor of the use 
of alcoholic stimulants to counteract the depressing influence of certain 
agents on the action of the heart — as, for example, aconite, veratrum 
viride, conium, digitalis, and the poison of venomous snakes. Before 
commencing the inhalation of chloroform, an ounce or two of whisky 
or brandy should be given the patient. This serves a double purpose : 
it sustains the heart and prolongs the chloroform narcosis. 

Alcohol in some form is constantly prescribed in low conditions in 
fevers, acute inflammations, and depressing maladies of all kinds. It 
is serviceable in these diseases when it lessens the pulse rate, but in- 
creases the contractile power of the heart and elevates the arterial 



478 CEREBRAL SEDATIVES. 

tension. It does harm when the pulse becomes more rapid and the 
blood-pressure is lowered by it. It does good when the tongue, be- 
fore dry, becomes moister under its use, and harm when the ''dryness 
of the tongue is increased. It does good when the temperature is re- 
duced, the delirium and subsultus lessened, and the sleep becomes 
more continuous and refreshing ; and does harm when it increases 
fever, exaggerates the delirium, and induces coma vigil. The chief 
utility of alcohol in these forms of disease is not as a stimulant, but 
as a food. It furnishes material, easily oxidizable, which can be ap- 
plied as nervous, muscular, and gland force. Furthermore it stimulates 
digestion, and enables more food to be taken and disposed of, and 
thus contributes indirectly to the maintenance of the powers of life. 
It follows from these considerations, that alcohol should be given in 
these low conditions of the organism, with milk, eggs, broth, and 
other suitable aliment. 

Undoubtedly the stimulant treatment of adynamic states is often 
carried to great excess. The large doses of alcoholic substances ad- 
ministered, disorder the stomach and suspend digestion ; and thus the 
condition of things which they are intended to relieve is only made 
worse. Furthermore, stimulants are excessively used in these disor- 
ders, from a wrong notion of their therapeutic action, and a conviction 
that diseases characterized by depression are best treated by arterial 
stimulants. The reaction which has set in against the antiphlogistic 
methods is in part answerable for the great freedom with which alco- 
hol is now used in fevers and inflammations. 

As respects its action on the nervous system, alcohol is a narcotic. 
It may be used to relieve pain, to promote sleep, and to quiet delirium. 
The various neuralgim may be temporarily alleviated by intoxicating 
doses of alcohol, but such a prescription is dangerous to the moral 
health of the patient. The subjects of neuralgia, or those who 
possess the neurotic temperament, have as a rule an inherited or 
acquired weakness of constitution, and a mobility of the nervous 
system, which render the effects of alcoholic stimulants peculiarly 
grateful. 

When wakefulness is due to a condition of cerebral anwmia, a full 
dose of some alcoholic fluid, whisky or brandy, will procure sound 
and refreshing sleep. In some subjects a glass of ale or beer answers 
better. Some cases of delirium tremens are greatly benefited by alco- 
holic stimulants. When the delirium is the result of sudden excess 
and of the direct action of the alcohol on the cells of the gray matter, 
the use of this agent will only add to the existing disorder ; but when, 
as is so frequently the case, the attack is determined by the failure of 
the stomach to appropriate not only the stimulant but the food also, 
the careful administration of alcoholic stimulants with suitable aliment 
renders an incontestable service. 



ALCOHOL. 479 

As alcohol stops waste, promotes constructive metamorphosis by- 
increasing the appetite and the digestive power, and favors the depo- 
sition of fat, it is directly indicated in chronic wasting diseases, espe- 
cially in phthisis. Clinical experience is in accord with physiological 
data : alcohol is an important remedy in the various forms of pulmo- 
nary phthisis. It is frequently given with cod-liver oil, or an ounce 
or two of whisky may be taken with some bitter or aromatic imme- 
diately after meals. If alcohol disagrees, if it does not improve but 
lessens the appetite, it will do harm in phthisis. It is an interesting 
fact that an intractable form of phthisis is induced by alcoholic excess. 

External Applications of Alcohol. — Equal parts of alcohol and 
water is an excellent evaporating lotion for the relief of superficial in- 
flammations — bruises, inflamed joints, orchitis, etc. Alcohol is an ex- 
cellent hemostatic for restraining oozing from a large surface. For 
suppurating wounds alcohol is an efficient antiseptic dressing — it de- 
stroys germs, removes fetor, and stimulates the tissues to more healthy 
growth. It favors the cicatrization of open wounds by coagulating 
the albumen and thus making an impermeable covering. It is a useful 
practice to wash the parts threatened with bed-sores with whisky or 
alcohol ; it hardens the cuticle, and prevents ulceration. /Sore nipples 
may be prevented by washing them with brandy after the child nurses, 
and then dusting them with bismuth carbonate. Brandy-and-water is 
an excellent lotion for mercurial and other forms of stomatitis requir- 
ing stimulant applications. Brandy-and-water is one of the thousand 
injections used in gonorrhoea. 

Authorities referred to : 

Anstie, Dr. Francis E. Stimulants and Narcotics, and various papers in The Prac- 
titioner. 

Baer, Dr. A. Der Alcoholismus, seine Verbreitung und seine Wirkung, etc. Berlin, 
1878, A. Hirschwald, pp. 621. 

Binz, Prof. Dr. C. Virchoio's Archiv, vol. li, p. 153. 

Ibid. The Practitioner, vol. iii, 1869, and vol. v, 1870. 

Dupre, A., Ph. D. The Practitioner, vol. viii, pp. 148, 224. The Elimination of 
Alcohol. 

Jones, Dr. C. Handfield. The Practitioner, vol. vii, p. 331. 

Lallemand, Perrin et Durot. Die Pole de VAlcobl et des Ancesthetiques dans V Or- 
ganisme, Paris, 1860. 

Lombard, Dr. J. S. New York Medical Journal, June, 1865. 

Murchison, Dr. Charles. A Treatise on Fevers, second edition, p. 230. 

Nicol, Dr. Patrick. Tlie British and Foreign Medico- Chirurgical Review, vol. 1, 
p. 203. 

Parses, Dr. E. A., and Count Cip. "Wollowicz. Experiments on the Effects of Alco- 
hol (ethyl alcohol) on the Human Body. 

Rabow, Dr. S. Berliner klinische Wochenschrift. Beobachtungcn uber die Wirkung 
des Alkohol auf die Korpertemperatur, 1871, p. 257, et seq. 

Richardson, Dr. B. W. The Medical Times and Gazette, December 18, 1869, p. 703. 

Ringer and Rikard. The Lancet, August 26, 1866, p. 208. 



480 CEREBRAL SEDATIVES. 

Vinum. — Wine. 

Vinum Album. — "White wine. A pale, amber-colored or straw- 
colored alcoholic liquid, made by fermenting the unmodified juice of 
the grape, freed from seeds, stems, and skins. . . . White wine should 
contain not less than ten per cent nor more than twelve per cent by 
weight of absolute alcohol. (U. S. P.) 

Vinum Album Fortius. — Stronger white wine. (White wine, seven 
parts ; alcohol, one part.) (TJ. S. P.) 

These are the only wines recognized by the United States Pharma- 
copoeia. In medical practice a great variety are employed, in accord- 
ance with special indications. It would occupy too much space, and 
be foreign to the purpose of this work, to enter into details in regard 
to particular wines, but some attention should be given to the different 
groups. 

Sparkling Wines. (Champagne, sparkling catawba, etc.) — These 
are wines which have been bottled before the stage of fermentation 
has been completed, hence they are lively, or sparkling, in consequence 
of being charged with carbonic acid. A considerable portion of the 
grape-sugar has not been converted into alcohol ; they are sweet wines, 
therefore, and the quantity of absolute alcohol which they contain is 
relatively low (eight to twelve per cent). Sparkling hock is a lighter 
wine than champagne, and contains less sugar. Sparkling catawba 
more nearly resembles hock than champagne. 

A sophistication now much practiced consists in adding to still 
wines carbonic-acid gas, by pressure, in the same manner that carbonic- 
acid water is manufactured. 

Dry Acid Wines. — The best specimens of this group are the Ger- 
man Rhine and Moselle wines, California hock, and Ohio and Kelly- 
Island catawba. The German varieties are very numerous, and are 
remarkable for their flavor, for the completeness of the fermentation 
(absence of sugar), and for their permanence. The most important 
of the varieties are the following : Durkheimer, Ungsteiner, Hoch- 
heimer, Deidesheimer, Forster, Rudesheimer, Johannisberger, Lieb- 
frauenmilch, etc. The French wines are, as a rule, rather acid. The 
best known are the clarets, but these are more properly classed with 
the red wines. 

Sweet Wines. — In this group are contained burgundy, still cham- 
pagne, muscatel, malaga, Hungarian tokay, and angelica, madeira, 
etc. The alcoholic strength of these wines, unless fortified, is rela- 
tively low, because the sugar has not been consumed by the fermen- 
tation. 

Light Red Wines. — The French clarets, the red Rhine wines, the 
American Ives's seedling, and Concord and Hungarian, are members 
of this group. They contain a large proportion of the coloring-matter 
of the grape, and considerable tannic acid. 



WINE. 481 

Heavy Red Wines. — Port is the principal representative of this 
group, but it is not a natural wine ; during the process of manufacture 
spirit is added, and its alcoholic strength is raised to thirty or forty 
per cent. California port when fortified, as it probably frequently is, 
should be classed in this division. 

Dry Spirituous Wines. — The most important member of this group 
is sherry. 

Composition and Properties. — The composition of wine is ex- 
tremely complex. The constituents ascertainable by chemical analysis 
do not represent all of the peculiar qualities which render various 
wines desirable. Bouquet and flavor can not be determined by the 
most expert chemist, and elude all other means of investigation but 
the tongue and nose of the " wine-taster." 

A wine is a solution of alcohol in water, mixed with various con- 
stituents of the grape. The proportion of alcohol ranges from six to 
forty per cent — the largest quantity being found in the artificial wines, 
such as port and sherry. The proportion of sugar varies greatly — 
from three to twenty-five per cent. The acids are fixed (tartaric) and 
volatile (acetic). The relation between these several constituents is 
nearly as follows : Port contains about fifty-three parts by weight of 
alcohol to one part of acid, and twelve parts of sugar to one part of 
acid. The average of sherry is thirty-nine of alcohol and 1*5 of sugar 
to one of acid. In the sweet wines, the average is about thirty parts 
of sugar to one part of acid and fifteen parts of alcohol. In the acid 
wines, the average proportion of alcohol to acid is as eighteen to one, 
while the sugar is almost absent, and in some of the best is entirely so. 
Those are dry wines which are free from sugar. Besides tartaric and 
acetic acids, wines contain, in much smaller quantity, malic, tannic, 
and carbonic acids. Wines containing less than three hundred grains 
of acid to the gallon are wanting in flavor ; on the other hand, an ex- 
cess of acid over five hundred grains to the gallon is too sour to be 
agreeable. The coloring-matter of wine varies greatly, and the dis- 
tinction between " white " and " red " depends on the quantity present 
in these different varieties. The red wines are more astringent, due to 
the larger proportion of tannin which they contain, and they are also 
rougher to the taste. 

Wine contains a great many mineral constituents ; tartrates of po- 
tassa and lime, chlorides of sodium, potassium, and calcium, and sul- 
phates of potassa and lime. The percentage of ash ranges from 0*18 
to 0*40. 

Note. — Among the best wines for medicinal use are the Hungarian wines of Mr. 
L. Reich, of New York. The tokay has fine bouquet and flavor and good body, and the 
red wine is a claret of excellent quality. These wines are to be commended because 
they present satisfactory evidence of being the product of the fermeutation of pure 
grape-juice. 

31 



482 CEREBRAL SEDATIVES. 

The peculiar odor of wine (bouquet) is due to cenanthic acid, and 
cenanthic ether, produced by a reaction of the acid on the alcohol. 

According to Fresenius, the quality of a wine is so much the better 
the less it contains of free acid, the more it contains of sugar, and 
the greater its quantity of extract / and, further, its quality is not de- 
cidedly influenced by the quantity of alcohol, and can not be deter- 
mined by its specific gravity. 

A certain quantity of free acid is necessary, but it should not be 
greater than can be masked by the alcohol, sugar, and extractive mat- 
ter. The flavor and odor of wine are produced by ethers formed by 
the action of the free acid on the alcohol ; hence the importance of 
this acid constituent. 

Dr. Druitt, in his " Report on Cheap Wines," has very welL summed 
up the qualities of good wine in the following conclusions : 

" 1. The wine should have an absolute unity, or taste as one whole. 

" 2. Wine should contain a certain amount of alcohol. 

" 3. Wine should be slightly sour. 

" 4. Sweetness is characteristic of a certain class of wines, while 
certain other wines are dry, or free from sugar. 

" 5. Wines should have a taste free from mawkishness, and indica- 
tive of instability. 

" 6. Roughness or astringency is a most important property, and 
belongs to most red wines. In moderation it is relished, as sourness 
is, by a healthy, manly palate, just as the cold souse is welcome to the 
skin. In excess it leaves a permanent harshness on the tongue. 

" 7. The wine must have body. This is the impression produced 
by the totality of the soluble constituents of wine — the extractive, that 
which gives taste to the tongue, and which, as wine grows older, is 
deposited along with the cream of tartar forming the crust 

" 8. Bouquet is that quality of wine which salutes the nose. Fla- 
vor is that part of the aromatic constituent which gratifies the throat. 

" 9. The wine must satisfy. A man must feel that he has taken 
something which consoles and sustains. Some liquids, as cider and 
thin wines, leave rather a craving, empty, hungry feeling after them." 

Physiological Actions. — As respects the alcohol which they con- 
tain, the physiological actions of wines could be discussed with the 
previous article. But wines differ from alcohol, and from brandy and 
whisky, not only in spirituous strength, but in the possession of the 
varied and important constituents mentioned above. 

The sparkling wines are more sedative to the stomach, and are 
more intoxicating, relatively to their alcoholic strength, than the other 
wines. As they contain a considerable quantity of unappropriated 
sugar, acid fermentation is apt to occur, and acidity, with headache, 
follows their use. As respects the influence on the pulse, they are less 
stimulating than the stronger wines, and the experiments of Dr. Ed- 



WINE. 483 

ward Smith have demonstrated that they increase the excretion of car- 
bonic acid. 

The dry acid wines are more purely stimulant, partly in conse- 
quence of their alcohol, and partly in consequence of the important 
ethers which they contain. As they are free from sugar, acid fermen- 
tation does not follow their use, but with some subjects the free acid 
present in them disagrees. 

The sweet wines have, generally, considerable body and alcoholic 
strength. They rather pall on the appetite ; are apt to disorder the 
stomach, and produce headache. Some of them have fine bouquet 
and flavor, and are satisfying to the palate ; but as a rule they are not 
borne as well as the dry wines. 

The red wines, light and dark, are astringent and have considerable 
body and alcoholic strength. The tannin which they contain, and 
coloring-matters, are apt to cause stomach-disorders, constipation, and 
a febrile state. By reason of the large amount of alcohol in them, 
especially in port, they approach whisky and brandy in power as 
stimulants and narcotics. 

Therapy. — 

" Good wine is a good familiar creature, if it be well used." (Othello.) 

The effervescing or sparkling wines often render important service 
in irritable states of the stomach without inflammatory action. The 
vomiting of pregnancy, of seasickness, of yellow fever, of cholera- 
morbus, icith depression, and of true cholera, are not infrequently ar- 
rested by tablespoonf ul-doses of iced champagne every fifteen minutes. 

A generous glass of a dry wine (sherry) taken with the principal 
meal greatly assists the digestion of the sedentary who suffer from 
atonic dyspepsia. The wine should be taken during the course of the 
meal, and at no other time. Persons who suffer from acidity, due to 
an excess of formation of acid gastric juice, are relieved by a dry acid 
wine, taken during the meal or just previously. For this purpose a 
genuine Rhine wine — for example, Forster Riesling — is best. 

In diarrhoea and dysentery, after the acuter symptoms have sub- 
sided, and when there is ' considerable depression, those wines are in- 
dicated which contain tannin — the red wines, claret, Ives's seedling, 
port, etc. 

In cases of anaimia and chlorosis, wines render an important ser- 
vice by increasing digestion and assimilation. To aid in this process, 
red wines with a good deal of sugar and extractives are most neces- 
sary. When wines produce headache, and the digestion is disordered 
by them, and the appetite impaired, they are not serviceable in these 
maladies. Moreover, for the nervous and hypochondriacal, wines must 
be prescribed with caution, for the habit of indulgence is quickly ac- 
quired by such subjects. In convalescence from acute diseases, there 



484 CEREBRAL SEDATIVES. 

can be no difference of opinion as to the great value of wine as a 
restorative. Wines of considerable body and alcoholic strength are 
indicated under these circumstances. When there is much nervous 
restlessness, wakefulness, and cardiac depression, a wine rich in ethers 
is specially useful, according to Anstie. In chronic wasting diseases, 
as phthisis, scrofula, etc., the stronger wines, as sherry, burgundy, 
port, may take the place, in some cases, of the spirits, whisky and 
brandy. In these wasting diseases, wines serve a double purpose : 
they stimulate the activity of the primary assimilation, and within 
certain limits they are utilized as foods. They are only harmful when 
digestion is impaired by them ; and under no circumstances can they 
take the place of other aliment. 

In passive haemorrhages, in the hemorrhagic diathesis and in pur- 
pura, wines are indicated, because they elevate the arterial tension, 
and thus act indirectly as haemostatics. 

In various acute diseases, when the action of the heart becomes 
feeble and irregular, the pulse dicrotic, and there occur wakefulness 
and delirium, a wine of considerable alcoholic strength and rich in 
ethers is peculiarly serviceable. Wines are much more largely used 
in fevers {typhoid, typhus, etc.) than in any other forms of disease, 
and the circumstances requiring their employment are indicated in the 
preceding sentence. The routine practice of alcoholic stimulation in 
fevers can not be justified. Exact indications for the use of wine 
exist in the state of the heart and arterial system, and of the brain, 
and these should be sought for in eveiy case, instead of prescribing 
for the name. In fevers, wines precede the spirituous liquors. The 
first weakening of the heart's action, the beginning of dicrotism, and 
the transitory delirium and subsultus, require champagne and the light 
and acid wines ; more profound adynamia, with diarrhoea, the stronger 
red wines. 

In acute inflammations (pneumonia, pleuritis, peritonitis, etc.), 
wines serve to maintain the strength when the powers of life are 
weakening, or to maintain the functions of brain and heart when 
crises occur, as in pneumonia. The rules for the administration of 
wine in acute inflammations are the same as in fevers. 

Next to their use in fevers, wines are most frequently prescribed, 
and with the greatest advantage, in surgical practice, for the conse- 
quences of wounds and injuries, to support the powers of life under 
protracted and profuse suppuration, and to favor digestion and as- 
similation in the course of convalescence from surgical diseases. 

The immediate stimulant effect of wine is of great value in sudden 
and profuse loss of blood, whether from injuries and surgical opera- 
tions, or post partum. A highly-etherized wine of good body is most 
useful here, because it produces a prompt effect and easily yields up 
the force needed to keep the heart and brain in action, and, in the 



MALT LIQUORS. 485 

case of the relaxed uterus, to furnish the power needed to procure its 
energetic contraction. 

Beer, Ale, Porter. — Beer and ale are fermented liquors made from 
malted grain, hops and other bitter substances being added. Ale is 
produced by rapid fermentation, in which the yeast rises to the sur- 
face, and beer is the product of slow fermentation in cool cellars, the 
yeast falling to the bottom. Hence the name lager-beer. Porter em- 
braces the qualities of beer and ale, and is so named on account of its 
strong quality, which endeared it to porters. 

Composition. — The proportion of alcohol varies somewhat. In 
Edinburgh ale it amounts to about six per cent ; in brown stout, to 
six per cent ; in porter, to four per cent ; in beer, two to three per 
cent. Besides alcohol and water, these malt liquors contain extract 
of malt, five to fourteen per cent ; carbonic acid, 0'16 to 0*60 per cent. 
In the extract are found also various aromatic substances, lactic acid, 
potash and soda salts, etc. 

Physiological Actions. — So far as the alcohol is concerned, beer, 
ale, and porter correspond in physiological actions to the spirituous 
liquors and to wines. As they contain malt extract, their nutritive 
value is greater than spirits and wine. An important constituent, the 
hop, being an aromatic bitter, the tonic and stomachic qualities of 
these malt liquors are also greater than their congeners. The process 
of fermentation, however, lessens in a remarkable degree the nutritive 
and stomachic qualities of the constituents which enter into the com- 
position of malt liquors. Their value as foods is much exaggerated 
by the habitual consumers. They increase the appetite and favor the 
deposition of fat. Although the malt beverages do not cause to any- 
thing like the same extent the alterations in the nervous centers pro- 
duced by the spirituous, they induce other and almost as important 
structural changes. They set up in the organism fatty degeneration 
of various tissues, notably of the liver and heart. The habitual beer- 
consumer is known by his obesity, his flushed face, embarrassed breath- 
ing, puffy hands, yellow conjunctiva, etc. ; he is usually short-lived, and 
the end is reached by hepatic and cardiac disorders. It is certainly 
true that a moderate amount of beer may be taken daily, for a life- 
time, without any obvious impairment of the functions ; but excessive 
use produces with great certainty the unfavorable effects above de- 
scribed. 

Therapy. — Beer, ale, and porter are not usually prescribed in acute 
maladies. They are, however, much and justly esteemed as stomachic 
tonics and restoratives in chronic wasting diseases — for example, in 
convalescence from acute diseases and surgical injuries, in cases of 
profuse and protracted suppuration, prolonged lactation, diseases of 
the joints, scrofula, phthisis, etc. Strumpf finds, however, that alco- 



486 CEREBRAL SEDATIVES. 

holic beverages only increase the amount of fat in milk, and not the 
quantity of milk as a whole. 

The malt liquors are harmful in all stomach-disorders with acidity, 
and in chronic affections of the liver, especially fatty liver. When 
these beverages do not improve the appetite, when they cause a sense 
of epigastric oppression, and when they coat the tongue, they are not 
beneficial. 

When wakefulness is due to cerebral ansemia, a glass of beer or 
ale at bedtime will frequently produce satisfactory sleep. Puerperal 
mania, delirium tremens, and acute maniacal delirium, when these 
symptoms coexist with a condition of adynamia, are greatly benefited 
by the liberal use of ale (pale or Edinburgh ale). The effect of this 
remedy is to arouse the appetite, to quiet delirium, and to produce 
sleep. In melancholia, excellent results are often obtained by the use 
of porter with a little tincture of opium. 

Extract of Malt. — Under this name is known a thick, sirupy 
liquid having a golden or yellowish-brown color, a sweetish taste, and 
the odor of malt. If properly prepared, it contains, besides the con- 
stituents of barley, the ferment diastase. It is much prescribed for 
its restorative qualities, and as a vehicle for cod-liver oil. It is best 
administered immediately after meals. 

Paraldehyde has recently attracted so much attention as an 
anodyne and hypnotic, that some reference to it becomes necessary. 
Under this name is described a polymeric modification of aldehyde. 
Above the temperature of 51° Fahr. it is a colorless liquid, having a 
peculiar ethereal odor, and a specific gravity of *998. It boils at about 
225° Fahr. It is soluble in eight parts of water at 52° Fahr. The 
dose ranges from 3 ss to 3 ijss. Water is a suitable menstruum. 

In appropriate cases it has proved to be an admirable hypnotic, 
with many of the qualities but none of the dangers of chloral. In its 
action, first the cells of the cerebrum are affected, and sopor is induced. 
Unlike the other agents of this class, its soporific action is not pre- 
ceded by excitement (Cervello). Next to the cerebral hemispheres 
the effects of paraldehyde are expended on the medulla oblongata, 
and then on the spinal cord. A lethal dose stops the functioning of 
the medulla and the respiratory center, but the cardiac functions cease 
after the respiratory. It differs from chloral in the important respect 
that it has no paralyzing action on the heart. The effect of paralde- 
hyde is, however, not so persistent as that of chloral, but the frequent 
repetition of the former with safety is more than a sufficient compen- 
sation for the greater power of the latter (Albertoni). 

Paraldehyde may be prescribed as a hypnotic in the conditions 
usually requiring such a remedy — in fevers, rheumatism, gout, prurigo, 
etc. (Morselli). It is, however, in mental and nervous disorders that 
it is likely to be most employed. By the Italian physicians, to whom 



ETHER. 487 

we owe its introduction, it has been very successfully used in acute 
mania, in the wakefulness of dementia paralytica, in hysterical seiz- 
ures, and in ordinary insomnia. To succeed, it must be given in 
sufficient quantity. The maximum dose mentioned above ( 3 ijss) 
has often been given without any ill effect or any after-trouble of 
any kind. 

iEther.— Ether, fiiher, Fr. ; Aether, Ger. 

A liquid composed of about seventy-four per cent of ethyl oxide, 
and about twenty-six per cent of alcohol containing a little water. 
Specific gravity about 0*750 at 60° Fahr. (IT. S. P.) 

^Zther Fortior. — Stronger ether. A liquid composed of about 
ninety-four per cent of ethyl oxide, and about six per cent of alcohol 
containing a little water. Specific gravity not higher than 0*725 at 
60° Fahr. 

A thin, very diffusive, clear, and colorless liquid, of a refreshing, 
characteristic odor, a burning and sweetish taste, with a slightly bit- 
ter after-taste, and a neutral reaction. It is soluble in all proportions 
in alcohol, chloroform, benzol, benzin, fixed and volatile oils, and dis- 
solves in eight times its volume of water at 60° Fahr. It boils at 98*6° 
Fahr. Ether is highly inflammable, and its vapor, when mixed with 
air and ignited, explodes violently. (U. S. P.) 

Spiritus ^Etheris. — Spirit of ether. Consists of ether, thirty parts ; 
alcohol, seventy parts. Dose, ttj, x — 3 j. 

Spiritus ^Etheris Compositus. — Compound spirit of ether. Hoff- 
man's anodyne. (Ether, alcohol, and ethereal oil.) A colorless, vola- 
tile, inflammable liquid, having an aromatic, ethereal odor, and a 
burning, slightly sweetish taste. Its specific gravity is 0*815. It is 
neutral, or but slightly acid to litmus. It gives only a slight cloudi- 
ness with chloride of barium ; but when a fluid ounce of it is evapo- 
rated to dryness with an excess of this test, it yields a precipitate of 
sulphate of barium, which, when washed and dried, weighs six and a 
quarter grains. When a few drops are burned on glass or porcelain, 
there is no visible residue, but the surface will have an acid taste and 
reaction. A pint of water, by the admixture of forty drops, is ren- 
dered slightly opalescent. Dose, til x — 3 j. (Pharm. 70.) 

Spiritus ^Etheris Nitrosi. — Spirit of nitrous ether. Sweet spirit 
of nitre. An alcoholic solution of ethyl nitrite, containing five per 
cent of the crude ether. (U. S. P.) Is a volatile, inflammable liquid 
of a pale-yellow color, inclining slightly to green, having a fragrant, 
ethereal odor, free from pungency, and a sharp, burning taste. It 
slightly reddens litmus, but does not cause effervescence when a crys- 
tal of bicarbonate of potassium is dropped into it. When mixed with 
half its volume of official solution of potassa previously diluted with 
an equal measure of distilled water, it assumes a yellow color, which 



488 CEREBRAL SEDATIVES. 

slightly deepens, without becoming brown, in twelve hours. A portion 
of the spirit in a test-tube half filled with it, plunged into water heated 
to 145°, and held there until it has acquired that temperature, will boil 
distinctly on the addition of a few small pieces of glass. 

Spirit of nitrous ether has a specific gravity of 0*837, and contains 
five per cent of its peculiar ether. It should not be long kept, as it 
becomes strongly acid by age. Dose, 3 ss — f ss. 

either Aceticus. — Acetic ether. Acetate of ethyl. A transparent 
and colorless liquid, of a strong, fragrant, ethereal, and somewhat ace- 
tous odor, a refreshing taste, and neutral reaction. Soluble in all pro- 
portions in alcohol, ether, and chloroform, and in about seventeen parts 
of water. Specific gravity, 0*889 to 0*897. It is inflammable. Dose, 
m x— 3 j. 

Ethyl Bromide. — Hydrobromic ether. Is a colorless liquid, vol- 
atile, having a fragrant odor, and a hot, somewhat sweetish taste, 
afterward rather bitter. It is not inflammable. Its specific gravity is 
1*420, and it boils at 104° Fahr. ; readily decomposes on exposure to 
light and air, bromine being separated. It is freely soluble in alcohol 
and ether, but very sparingly in water. Dose, for internal and sub- 
cutaneous administration, tt], x — 3 j. 

Antagonists and Incompatibles. — Ether dissolves iodine, bro- 
mine, corrosive sublimate, the volatile and fixed oils, many resins and 
balsams, tannin, caoutchouc, most of the alkaloids, sulphur, and phos- 
phorus — the last-named two sparingly. As respects its stimulant and 
anodyne properties, it is antagonized by arterial sedatives, quinine, 
oxygen, protoxide of nitrogen, the tetanizing alkaloids, strychnine, 
picrotoxin, etc. 

Synergists. — Alcohol and its congeners, chloroform, arterial stimu- 
lants, cerebral stimulants, etc., assist the action of ether. 

Physiological Actions. — The physiological effects of ether when 
inhaled require separate treatment ; hence the subject of anaesthesia 
by vapors will be discussed in a special article. It is now proposed 
to treat of the effects of ether administered by the usual route — the 
stomach. 

Ether has a taste at first sweetish, but afterward hot and pungent. 
It leaves a cooling sensation in the stomach after the subsidence of 
the burning, and this quickly diffuses over the body. Increased action 
of the heart, flushing of the face, warmth of the surface, with increased 
diaphoresis, follow in a few minutes. The senses are quickly excited, 
the mind becomes more active, ideas flow rapidly, and the cerebral 
phenomena of alcoholic intoxication ensue. These effects are of short 
duration, and a feeling of content, mental calm, and sopor, succeeds 
to the transient excitement. Ether is eliminated rapidly, chiefly by 
the lungs, and the whole duration of the effects of even a large quan- 
tity ( 3 ij) does not exceed an hour. 



ETHER. 489 

Therapy. — Before it is administered, ether should be diluted with 
alcohol, which renders it readily miscible with water. 

A few drops of Hoffman's anodyne (th, x — in, xx) in some camphor- 
water is an excellent remedy to expel flatus from the stomach. Gas- 
tralgia may often be quickly relieved by the same means. A few 
drops of ether, added to cod-liver oil, enable the stomach to bear it 
more easily, and, it is said, favors its digestion ; that it accomplishes 
this object by increasing the pancreatic juice, is the observation of 
Claude Bernard. Paroxysms of hepatic colic are sometimes treated by 
the internal administration of ether, but this treatment is by no means 
equal in effectiveness to the inhalation of the vapor. Ether mixed 
with turpentine has the power to dissolve hepatic calculi, hence the 
remedy of Durande. As Trousseau well remarks, chemical results 
which take place in the laboratory are not reproduced in the body 
with equal facility. The rapidity with which ether diffuses into the 
blood at the temperature of the stomach would appear to preclude the 
possibility of its exerting any solvent action on a calculus fixed in an 
hepatic duct. Whatever good result is secured by the administration 
of the remedy of Durande must be ascribed to the anodyne and anti- 
spasmodic action of its constituents. 

Sudden failure of the heart' 1 s action (syncope), from mental emo- 
tion or hysteria, is most promptly remedied by the administration of 
Hoffman's anodyne. Mild attacks of angina pectoris, and of spas- 
modic asthma, may sometimes be aborted by a full dose of the ethe- 
real preparations. The subcutaneous injection of ether is very effec- 
tive in sudden cardiac depression. 

Nervous or hysterical sick-headache is quickly cured by 3 ss doses 
of spirit of ether. The most important application of these ethereal 
remedies is in the treatment of the hysterical paroxysms. As the ac- 
tion is prompt and quickly expended, it is obvious that ether or Hoff- 
man's drops are only adapted to sudden hysterical seizures, and not to 
more lasting nervous symptoms arising in an hysterical constitution. 
Nothing can be more satisfactory than the prompt relief by these 
agents of hysterical flatulence, globus hystericus, and hystero-ep>ilepsy. 
$ Spts. etheris composit., tinct. valerian, amnion., aa J j. M. Sig. : 
A teaspoonful in water every flfteen minutes until relieved. 

As a cardiac stimulant in fevers, the ethereal preparations are oc- 
casionally prescribed. For a quick effect, in an emergency of practice, 
they are useful, but are not equal to spirits and wine when a sustained 
effect is required. 

Nitrous ether is employed in domestic practice as a mild diapho- 
retic, a diuretic, and carminative. It no longer occupies the place it 
formerly held in medical practice, but it is occasionally prescribed in 
feverishness, as a constituent in expectorant mixtures, in combination 
icith diuretic medicines, etc. 



490 CEREBRAL SEDATIVES. 

Ether by the Hypodermatic Method. — Within the past few 
years, the subcutaneous injection of ether has taken an important posi- 
tion in therapeutics. It is necessary, therefore, to enter into this sub- 
ject fully. 

When ether is injected beneath the skin, more or less burning pain 
is felt at the point of insertion, and a puffy swelling is produced. In 
most subjects this swelling subsides in an hour or two, and no trace is 
left of the operation. In some instances, an induration, the size of a 
filbert, forms, and slowly disappears. Yery rarely inflammation is set 
up about the site of the injection, and followed by suppuration, with 
more or less sloughing. If not too large an amount, suddenly and vio- 
lently injected, is used, there will be no untoward results. 

The effects of ether subcutaneously are the same in kind as, but 
more powerful in degree than, those produced by the stomachal admin- 
istration. A local anaesthetic impression is made ; in a few seconds, 
the action of the heart is powerfully increased, and soon the usual cere- 
bral effects are manifest. 

Ether was first employed subcutaneously by Dr. Comegys, of Cin- 
cinnati, in the treatment of sciatica. He injected from fifteen minims 
to a half-drachm, in the neighborhood of the affected nerve. This 
practice has been followed by others with success, and is now more or 
less widely used as a substitute for " the deep injection of chloroform." 
It is very desirable to have some exact observations which will deter- 
mine the comparative value of these expedients. 

The most important applications of ether, hypodermatically, are as 
a cardiac stimulant in the case of sudden and extreme depression of 
the heart, and as a general stimulant in adynamic states. In the de- 
pression caused by haemorrhage, whether pulmonary or post partum, 
the injection of ether may obviate the necessity for transfusion. This 
practice is strongly urged by Peter, Fereol, and Mile. Ocoumkoff, who 
report cases in confirmation. Remarkable results have been effected 
by the subcutaneous injection of ether in adynamic pneumonia (ty- 
phoid pneumonia), as practiced by M. Barth. Thus, of fourteen cases 
of severe type treated by these injections, eleven were cured. The 
quantity injected was about fifteen to twenty minims two, three, or 
four times a day, according to the degree of adynamia. The effects 
which follow almost immediately are these : the respiration becomes 
more easy, the pulse takes on more strength and volume, the tongue 
moistens, and the countenance assumes a better appearance. In from 
two to three minutes after the injection has been practiced, the odor 
of ether is recognizable in the breath (Barth). 

In the eruptive fevers, especially in variola, the injections of ether 
have been used with admirable results (Castel). It is in a high degree 
probable that the same treatment will prove very useful in low forms 
of septic and inflammatory diseases in general. There can scarcely 



CHLOROFORM. 491 

be any doubt that we have in this method a most useful addition to 
our therapeutical resources. 

In place of ether, hydrobromic ether has been utilized in the treat- 
ment by the subcutaneous method of various spasmodic diseases, as 
ic hooping-cough, chorea, asthma, and similar affections. 

Chloroformum. — Chloroform. Chloroforme, Fr. ; Chloroform, Ger. 

Chloroformum Venale. — Commercial chloroform. A liquid con- 
taining at least 98 per cent of chloroform. It has nearly the same 
sensible properties as purified chloroform. Its specific gravity should 
not be lower than 1*470. 

Chloroformum Purification. — Purified chloroform. A heavy, clear, 
colorless, diffusive liquid, of a characteristic pleasant ethereal odor, a 
burning sweet taste, and a neutral reaction. Soluble in about two hun- 
dred parts of water, and in all proportions in alcohol or ether ; also in 
benzol, benzin, fixed or volatile oils. Sp. gr. 1*485-1*490 at 60° Fahr. 

If five cubic centimetres of purified chloroform be thoroughly agi- 
tated with ten cubic centimetres of distilled water, the latter, when 
separated, should not affect blue litmus-paper (absence of acids), nor 
test-solution of nitrate of silver (chloride), nor test-solution of iodide 
of potassium (free chlorine). If a portion be digested warm with solu- 
tion of potassa, the latter should not become dark-colored (absence of 
aldehyde). If a few cubic centimetres be permitted to evaporate from 
blotting-paper, no foreign odor should be perceptible after the odor of 
chloroform ceases to be recognized. (U. S. P.) 

When shaken with an equal volume of sulphuric acid, in a bottle 
closed by a glass stopper, and allowed to remain in contact twenty- 
four hours, no color is imparted to either. "When one fluid drachm is 
evaporated spontaneously with one drop of a neutral, aqueous solution 
of litmus, the color of the latter is not reddened. The result of the 
test is the same if the chloroform contained in a white glass bottle has 
been previously exposed to direct sunlight for ten hours. 

Mistura Chloroformi. — Chloroform mixture.- Purified chloroform, 
eight parts ; camphor, two parts ; fresh yolk of egg, ten parts ; water, 
eighty parts. M. Dose, a tea to a tablespoonful. 

Spiritus Chloroformi. — Spirit or chloroform. Purified chloroform, 
ten parts ; alcohol, ninety parts. Dose, 3 ss — 3 j. 

Antagonists and Incompatibles. — Chloroform separates from the 
mixture when prescribed with weak spirits or glycerin. It is soluble 
in alcohol (ten to six), in ether (one to seven), in water (one to two 
hundred). It dissolves very freely in olive-oil and turpentine, but does 
not dissolve in or mix with glycerin. It has very extensive solvent 
power, dissolving caoutchouc, gutta-percha, mastic, tolu, benzoin, co- 
pal, among the gums ; iodine, bromine, the organic alkaloids ; fixed 
and volatile oils, resins, and fats. In cases of poisoning by the inter- 



492 CEREBRAL SEDATIVES. 

nal administration of chloroform, the treatment should be conducted 
on the same plan as for irritant poisons. There is no chemical anti- 
dote. To overcome its effects on the respiratory and circulatory sys- 
tems, artificial respiration, cold affusion, and galvanism, may be em- 
ployed. 

Synergists. — Anesthetic agents, opium, chloral, alcohol, etc., pro- 
mote the action of chloroform. 

Physiological Actions. — The taste of chloroform is hot, sweetish, 
and pungent. Undiluted it excites violent irritation and inflammation 
of the mucous membrane. In passing through the fauces the vapor 
may enter the larynx in such quantity as to cause great heat and in- 
flammation, followed by oedema. In the stomach, chloroform produces 
a feeling of warmth, followed by coldness, like ether ; but, when taken 
in large quantity undiluted, violent gastritis. Besides the local action, 
chloroform diffuses into the blood, and affects distant parts. Like 
alcohol and ether, it increases the action of the arterial system, and 
occasions excitement of the brain, followed by sopor. In lethal doses 
profound stupor and insensibility are produced by it. 

Therapy. — A little chloroform (t7[ ij — v\ v), dropped on sugar and 
swallowed, will remove some kinds of nausea and vomiting. It can 
be useful in non-inflammatory states only, as, for example, seasickness, 
the vomiting of pregnancy, sick-headache, etc. Gastralgia may some- 
times be relieved in the same way. The following formula is an effec- 
tive remedy for flatulent colic : IJ Spirit, chloroformi, tine, carda- 
momi comp., aa § ij. M. Sig. : A teaspoonfid every half-hour in 
water. Hepatic and saturnine colic are also benefited by chloroform, 
but the addition of opium increases its efficacy, and is usually neces- 
sary in these cases. Chloroform is a solvent of biliary calculi, and 
has been prescribed with the view to effect a solution of calculi con- 
tained in the gall-bladder, or lodged in the hepatic duct. It undoubt- 
edly affords some relief, but not probably because of its solvent 
action. As has been remarked of ether, it is in the highest degree 
improbable that sufficient chloroform, even when it is administered in 
large doses, can reach the calculus to effect its solution, when experi- 
ments out of the body have shown that some hours are required to 
dissolve a calculus immersed in chloroform. In irritable ulcer of the 
rectum, and itching about the anal region, an ointment of chloroform 
gives great relief : I£ Ung. zinci oxidi, § j ; chloroformi, 3 j. M. Ft. 
ung. The vapor of chloroform may be applied directly to these parts. 

In hay-asthma, whooping-cough, spasmodic asthma, irritable reflex 
cough, the vapor of chloroform may be used as follows : To a cup of 
warm water, 80° to 100° Fahr., add a teaspoonful of spiritus chloro- 
formi, and repeat every five minutes. This inhalation should not be 
used except in the presence of a medical man, and not more than five 
teaspoonfuls should be inhaled at a time. The patient should inhale 



CHLOROFORM. 493 

the vapors as they arise, directing them into the air-passages from the 
cup by a paper shield. A little chloroform (a minim or two) is a use- 
ful constituent of expectorant mixtures, when a neurotic element is 
present. 

Chloroform is a very valuable hypnotic in delirium tremens. It is 
unsafe when used by inhalation in the treatment of this affection, but, 
by the stomach, not unfrequently excellent results are obtained from 
it. It is contraindicated when there are a vigorous action of the heart 
and an elevated state of the arterial tension, and useful when symp- 
toms of depression and adynamia are present. It should be given in 
the form of the spirit. I£ Spirit, chlorof ormi, tinct. capsici, aa f j. M. 
Sig. : A teaspoonful in water every half -hour, hour, or two hours. 

Neuralgia. — Chloroform is extremely valuable in the treatment of 
this disease, and it is the most effective when used by the method of 
" deep injection," first proposed by the author. This plan of treat- 
ment consists in the injection deeply, in the neighborhood of the 
affected nerve, of five to fifteen minims of pure chloroform. The offi- 
cial spirit of chloroform, ether, or even alcohol, may be used for this 
purpose. The first named, in the quantity of fifteen minims, is prob- 
ably the best. Rarely does any local mischief result from these in- 
jections, except a temporary induration. The author has procured by 
this means apparently permanent relief to long-standing cases of neu- 
ralgic pain (tic-douloureux) affecting the superficial divisions of the 
fifth. Other practitioners have been equally successful, and the cases 
thus treated now include neuralgic affections of the most important 
nerves. 

Pain in superficial nerves may sometimes be relieved by the local 
application of chloroform. $ Chlorof ormi, tinct. aconiti rad., aa § ss ; 
liniment, saponis, f j. M. Sig. : Liniment. A piece of flannel, moist- 
ened with this, is applied to the painful part, evaporation being pre- 
vented by a covering of oiled silk. The pain of dysmenorrhea is 
relieved by the local application of chloroform-vapor, and of sciatica, 
lumbago, myalgia, and similar affections, by chloroform applied di- 
rectly to the parts. Nervous headache may sometimes be cured by 
a little chloroform in a watch-glass applied to the temple. 

An impending paroxysm of intermittent may be prevented by a 
full dose of chloroform ( 3 j — 3 ij ) administered before the onset 
of the chill. The inhalation of chloroform is used for the same 
purpose. 

A few drops of chloroform, frequently repeated, is an excellent 
means of relief in cholera. It allays nausea and vomiting, arrests 
diarrhoea, relieves the cramps, and restores the temperature. It may 
be given in the form of spiritus chlorof ormi, or of chlorodyne, a very 
celebrated empirical remedy. No single remedy has been more effica- 
cious than chlorodyne in the treatment of true cholera. 



494 CEREBRAL SEDATIVES. 

Chloroform as a Counter-irritant. — When chloroform is applied to 
the skin and evaporation prevented, it causes heat, redness, and even 
vesication. Frequently, chloroform is used locally to produce this 
effect, but usually in combination with other counter-irritants, IJ 
Chlorof ormi, ol. terebinthinas, aa § j ; lin. saponis, f ij. M. Sig. : 
Liniment. IJ Chlorof ormi, lin. camphoras, aa § j. M. Sig. : Lini- 
ment. These are elegant counter-irritant applications, in cases requir- 
ing the milder remedies of this class, and are used in various internal 
inflammations and local affections characterized by pain. Commercial 
chloroform can be used in preparing them. 

Chlorodyne. — This empirical preparation is largely used in cholera, 
and in painful diseases requiring an anodyne. Numerous formulas have 
been published, but none of them appear to possess the exact qualities 
of the original preparation by Dr. J. C. Browne. The dose of the 
genuine chlorodyne ranges from ten to thirty drops. The following 
formula makes a product more nearly resembling the original than any 
other known to the author : 

Chloroform 4 ounces. 

Ether 1 ounce. 

Alcohol N . 4 ounces. 

Treacle 4 ounces. 

Extract of licorice 2^ ounces. 

Muriate of morphine 8 grains. 

Oil of peppermint 16 minims. 

Sirup 17-J- ounces. 

Acid, hydrocyan. dil 2 ounces. 

Dissolve the muriate of morphine and the oil of peppermint in the 
alcohol, mix the chloroform and ether with this solution, dissolve the 
extract of licorice in the sirup, and add the treacle ; shake these two 
solutions together, and add the hydrocyanic acid. Dose, five to fifteen 
minims. 

Some of the published formulas contain resin of cannabis Indica, 
atropine, perchloric acid, in addition to the ingredients above given. 

Another chlorodyne, known as " Gilman's," has many advantages, 
and is now widely used. Its composition is as follows : Purified chlo- 
roform, 3 ij ; glycerini, f ij ; spts. vini rect., J ij ; acid, hydrocanic. dil., 
3 ij ; tinct. capsici, 3 ij ; morphinas muriatis, gr. viij ; syrupi (treacle), 
| iij. M. The dose of this chlorodyne for an adult is a teaspoonful. 
In prescribing the various mixtures known by the common name — 
chlorodyne — the strength should be ascertained before administering. 

The following formulas (Fox) are very efficacious in the local affec- 
tions for which they are recommended : 

IJ Chloroformi, ill, vj ; cucumber cerate, § j. M. Sig. : Ointment 
for pruritus. IJ Plumbi carbonat., 3 ss ; chloroformi, th, iv ; ung. 
aquas rosas, § j. M. Sig. : Ointment for pruritus, IJ Chloroformi, 



ANAESTHETICS. 495 

■nt viij ; glycerin., 3 j ; ung. simplicis, 3 vj ; potassii cyanidi, grs. iv. 
M. Sig.: Ointment for pruritus. I? Morphinae acetat., 1 part ; chlo- 
roform, 8 parts ; lard, 60 parts ; oil of sweet almonds, 40 parts. M. 
An ointment to be applied several times a day in pruritus pudendi. 

Authorities referred to : 

Bartholow, Dr. Roberts. On the Deep Injection of Chloroform for the Relief of Tic- 
Douloureux. The Practitioner, July, 18*74, p. 9. 

Fournier, Dr. H. Annuaire de TMrapeutique, 1879, pp. 68-70. 

Fereol, Dr. Injections Sous-cutanees de Chloroforme. Annuaire de Therapeulique, 
1879, p. 68. 

Gubler, Dr. Adolph. Commeniaires Therapeutique du Codex Medicamentarius, p. 670. 

Husemann, Dr. Theodor. Handbuch der gesammten Arzneimittellehre, zweiter Band, 
1869. 

Trousseau et Pidoux. Traite de Therapeutique et Matiere Medicate, eighth edition. 

ANAESTHETICS AND ANESTHESIA. 

either Fortior. — The stronger ether. 

Chloroformum Purificatum. — Purified chloroform. 

Neither of these anaesthetics should be used until its conformity to 
the standard of the United States Pharmacopoeia has been ascertained. 
The tests of purity are given under their respective heads in the pre- 
ceding article. 

The term anaesthetic, proposed by Dr. Oliver Wendell Holmes, 
means an agent capable of producing ancesthesia, or insensibility to 
pain. It is true, anaesthesia is a term which, according to its etymo- 
logical signification, should be applied to loss of sensation of touch, 
chiefly, and analgesia should be used to signify loss of the sense of 
pain ; but the word ancesthesia, as expressive of the state of profound 
unconsciousness induced by anaesthetics, is now so firmly established 
by usage that it were better to retain it. Insensibility to pain (anal- 
gesia) may be produced, without simultaneous loss of common sensation, 
touch (anaesthesia). By the inhalation of ether, chloroform, bichloride 
of methylene, nitrous oxide, and some other agents, the functions of 
animal life can be so far suspended that surgical operations involving 
intense pain, and certain natural processes, accompanied by great suf- 
fering, can be performed entirely without the consciousness of the 
subject concerned. 

Physiological Actions. — When the vapor of ether or chloroform 
is inhaled, a sense of faucial irritation and of the need of air is expe- 
rienced, and more or less cough is produced. The irritation of the 
fauces excites the flow of mucus, and the reflex act of swallowing. 
The feeling of need of air causes the patient to push aside the inhaler 
or sponge, and in children may lead to violent struggling. The sensi- 
bility of the glottis is soon diminished, the coughing ceases, and the 
inhalation then proceeds quietly. 



496 CEREBRAL SEDATIVES. 

The first effect is a general exhilaration, the pulse increases in fre- 
quency, the respirations become more rapid, and sometimes assume a 
sobbing or convulsive character ; the face flushes ; talking, laughing, 
crying, singing, and sometimes praying, indicate the cerebral intoxica- 
tion. This stage of excitement varies in duration in different indi- 
viduals, and is more pronounced in character and more persistent in 
those of mercurial disposition, and in the hysterical. At this period, 
although the patient can be easily aroused, sensibility to pain is de- 
cidedly diminished ; although the sense of touch may be preserved, 
taste and smell are abolished, and the sight is either abnormally acute 
or is perverted by illusions. If the inhalation be continued, the patient 
passes into the condition of complete insensibility. In women and 
children, and males reduced by illness, the production of insensibility, 
if the anaesthetic be not inhaled too rapidly, takes place quietly ; but, 
if the subject be a robust male, in full health, especially if the inhala- 
tion has been proceeded with rapidly, the stage of insensibility is pre- 
ceded by a tetanic convulsive stage, in which the voluntary muscular 
system and the respiratory muscles become rigid, the breathing ster- 
torous, the face cyanosed. This condition of rigidity is similar to, if 
not identical with, the tetanic stage of the epileptic paroxysm. If the 
inhalation of the anaesthetic be pushed still further, the tetanic rigidity 
subsides, the cyanosis disappears, the breathing proceeds quietly, and 
a condition of complete muscular relaxation, and of abolition of reflex 
movements, is established. When this is accomplished, the arm drops 
without resistance when let fall, the conjunctiva is insensible to irri- 
tation, the pupils do not alter in size when exposed to light, and no 
mechanical irritation awakens the least consciousness of pain. The 
surface is cool, and bathed with abundant perspiration, the counte- 
nance is placid, the eyes closed, the pupils rather contracted than di- 
lated ; the respiration easy, but more shallow than normal ; the pulse 
slower — it may be feebler, it may be stronger than in health. The 
functions of the cerebrum are suspended ; only the lower centers, pre- 
siding over respiration and circulation, continue in action. Out of this 
condition, and without interference, the patient will presently emerge. 
If, however, the inhalation be continued, these organic functions will 
be suspended, and life will be terminated by the cessation of the action 
of the heart and of the respiratory organs. 

There are several modes of dying from anaesthetic vapors : 
1. By the first mode, the death is sudden and occurs very soon 
after the inhalation has begun, and is ascribed to "irritation of the 
peripheral nervous system, accumulation of carbonic acid in the blood, 
and arrest of the action of the heart." This explanation, the author 
submits with diffidence, seems very unsatisfactory, for phenomena of 
this kind, up to the point of cardiac paralysis, must ensue in all cases 
of chloroform narcosis. The sudden death, at the beginning of inha- 



ANESTHETICS. 497 

lation, seems to be more properly explicable on the theory tbat the 
first chloroform vapor which reaches them paralyzes the cardiac gan- 
glia, already in an abnormal state of susceptibility from causes not 
now understood, for this accident sometimes occurs in persons who 
have previously taken the anaesthetic without unfavorable symptoms 
of any kind. 

2. By the second mode, called by Richardson epileptiform syncope, 
death ensues in the stage of rigidity preceding complete muscular 
relaxation, and is due to tetanic fixation of the respiratory muscles, 
and consequent interference with the pulmonary circulation, accu- 
mulation of blood on the venous side, and arrest of the heart's action. 
In these cases respiration ceases before the pulsations of the heart 
cease. 

3. By paralysis of the respiratory muscles. Death ensues during 
the stage of complete muscular relaxation, and the action of the heart 
continues for some seconds, or even minutes, after respiration has 
ceased. 

4. By paralysis of the heart. This also occurs in the course of 
complete insensibility ; the motor ganglia are paralyzed, and the heart 
suddenly ceases to act, the respiration continuing for a short time 
longer. 

5. This mode of dying is made up of two factors : depression of 
the functions by chloroform narcosis, and the shock of the accident, 
or the surgical operation. Death may ensue during the inhalation, 
or may occur afterward. 

COXDITIOXS OF THE OeGANISM EEXDEEIXG THE USE OF AxJES- 

thetics daxgeeous. — Experience has demonstrated that old drunk- 
ards are peculiarly unfavorable subjects. When tumor or abscess of 
the brain exists, it is dangerous to administer anaesthetics. Instances 
of sudden death under these circumstances are relatively numerous. 
Very much enlarged tonsils, swollen epiglottis, oedema of the glottis, 
are contraindications, but not insuperable, to the use of anaesthetics. 
Emphysema of the lungs is so frequently accompanied by ischaemia 
of the arterial, and engorgement of the venous side of the systemic 
circulation, and with dilatation of the right cavities, that it must be 
considered a dangerous state in which to administer chloroform, or 
even ether. Fatty change in the muscular substance of the heart 
must be considered peculiarly unfavorable, for more deaths have en- 
sued from this cause than any other. 

Chloroform and ether have been administered with safety in cases 
of phthisis and heart-disease (valvular lesions), the muscular substance 
and its contained ganglia being free from structural change. 

Experience has abundantly demonstrated that those reduced by 
illness and disease, and the feeble, bear anaesthetics better than the 
healthy and robust ; that children and women are better subjects than 
32 



498 CEREBRAL SEDATIVES. 

adults and men ; that anaesthetics are safer when given for operations 
for disease than for injury. 

Incomplete anaesthesia is a condition of danger. Numerous acci- 
dents have occurred from the use of anaesthetics for trivial operations 
— notably for extraction of teeth — in which but a partial degree of 
insensibility is induced. In such cases the heart, enfeebled by chloro- 
form narcosis, is suddenly paralyzed by the reflex action proceeding 
from the peripheral injury. The district of tissue supplied by the 
fifth nerve is an especially dangerous region, owing doubtless to the 
intimate connection of the nucleus of the fifth with the nucleus of the 
pneumogastric. By far the largest number of fatal cases have resulted 
from a neglect of this rule : it is never safe to proceed in a surgical 
operation with anaesthetics, unless complete insensibility has been pro- 
duced. The author is aware that Trousseau and Pidoux have attrib- 
uted the number of cases of fatal chloroform narcosis, which have 
occurred in England, to the fact that the just-mentioned rule is ad- 
hered to by English surgeons. Their words are as follows : " En 
Angleterre, les chirurgiens portent V etherisation jusqu?d V abolition de 
toutes les facultes animales i jusqu'au commencement de la periode 
d'etherisme orga,nique. Plus prudents sous ce rapport que leurs con- 
freres de la Grande- Br etagne, les chirurgiens franpais ont V habitude 
de s'arreter des que la sensibilize aux excitations de la peau est abolie 
et que la resolution musculaire commence. Cette prudence explique 
comment les chirurgiens franpais ont eprouve moins d 'accidents graves 
et compte moins de morts subites." (Vol. ii, p. 322.) 

Modes of conducting the Inhalation. — After ascertaining that 
none of the contraindications mentioned above exist, the patient may 
be prepared for the inhalation of the anaesthetic vapor. The inhala- 
tion should not be proceeded with soon after a full meal. Vomiting, 
as the narcosis subsides, is usual, and, as the insensibility of the glottis 
persists for some time afterward, particles of food may be lodged in 
the chink, causing fatal suffocation. Several cases of this kind have 
been reported. On the other hand, it is bad practice to administer 
an anaesthetic after a prolonged period of fasting, for the exhaustion 
thereby induced may be an influential factor in determining a fatal 
result. Before the inhalation is begun, it is proper to administer an 
ounce or two of whisky or brandy. Much more important is the ex- 
pedient proposed by Bernard and afterward by Nussbaum, to premise 
a subcutaneous injection of morphine. Bernard proposed to administer 
the morphine before beginning the inhalation ; whereas Nussbaum 
used it after unconsciousness to pain had been produced. The ad- 
vantages of the former method are obvious. When the morphine 
influence takes place, the inhalation will proceed quietly without the 
struggling and coughing, and spasmodic breathing, which so interfere 
with the administration of anaesthetics, especially of ether. The use 



ANAESTHETICS. 499 

of morphine subcutaneously also lessens materially, if not prevents 
entirely, the stage of rigidity and spasm. The quantity of the anaes- 
thetic required is much less, and the stage of insensibility more pro- 
longed, when morphine is thus given. 

Besides the foregoing conspicuous advantages derived from the 
preliminary subcutaneous injection of morphine, there can be no doubt 
that this agent antagonizes the paralyzing action of the anaesthetic on 
the cardiac and respiratory centers, and prevents the subsequent shock 
due to the administration of the ana3sthetic and the performance of a 
surgical operation. 

The proposal of Bernard, as subsequently advocated by Nussbaum, 
was some time afterward strongly urged by the late Prof. William 
Warren Greene, M. D., of Pittsfield, Massachusetts, and Dr. J. C. 
Reeve, of Dayton, Ohio. Soon after the publication of Bernard's 
observations, the author, in his "Manual of Hypodermatic Medica- 
tion," proposed the use of morphine and atropine combined as more 
perfectly realizing the object contemplated. Since this time, at Lyons, 
the combination of morphine and atropine has been largely employed 
preliminary to ether inhalation. The method is known as "anesthe- 
sies mixtes" or, anaesthesia by a mixed method (Aubert). The addi- 
tion of atropine is to increase the forces of the antagonism against the 
depression of the cardiac and respiratory functions. The experience 
of the Lyons school is decidedly in favor of the method of mixed an- 
aesthesia. Adverse reports from other quarters, however, have not 
been wanting, but the relevancy of their facts is doubtful. 

When the anaesthetic is about to be administered, the operator 
should, by a cheerful and confident manner, remove the fears of the 
patient. None of the paraphema of the operation to be performed 
should be exhibited before the patient, and no remarks should be made 
in his hearing regarding his case, the anaesthetic sleep, or the surgical 
procedure. Only the physician having the administration of the an- 
aesthetic in charge, and the necessary assistants, should be present in 
the apartment. An abundant supply of fresh air should be insured 
to the patient, and all the appliances required for resuscitation should 
be at hand, but not ostentatiously paraded before the patient. 

The simplest apparatus only is required. Complicated inhalers 
have, as frequently as the towel or the handkerchief, been used in 
fatal cases of chloroform narcosis. A cone of stiff paper, lined with 
lint or felt, and large enough to cover the nose and mouth of the 
patient, is the best form of inhaler for the administration of ether. 
Lente's ether-inhaler consists of a cone of hard rubber lined with felt, 
and having attached to the apex a flexible rubber tube communicating 
with the ether-bottle. This is a very satisfactory apparatus. A simi- 
lar but much less complicated and expensive inhaler is that of Dr. Allis, 
of Philadelphia. The utility and desirableness of this apparatus are 



500 CEREBRAL SEDATIVES. 

much commended by Prof. William Goodell. When ether is inhaled, 
the atmosphere is, as far as possible, excluded, in order that the anaes- 
thetic effect may be quickly induced. The important point in the 
administration of chloroform is to secure such an admixture of atmos- 
pheric air as that the amount of chloroform-vapor shall not exceed 
three and a half per cent. If this rule be regarded, the form of in- 
haler is of little importance. The original method of Simpson con- 
sisted in applying the vapor by dropping slowly chloroform on a piece 
of thin cloth laid over the mouth and nose, or by a linen handkerchief 
moistened with half a drachm. The mouth and nose should be pro- 
tected from the irritant action of the chloroform by inunction with oil. 

A cone made of a towel, having a large opening at the apex, and 
containing a suitable, very porous sponge, is now probably more em- 
ployed than any other form of inhaler for giving chloroform. The 
typical method for administering it is that of Snow : in a bag of suit- 
able size the vapor of chloroform is mixed with air in the proper pro- 
portion, and then given directly ; but, obviously, such an arrangement 
is not often available. 

In administering the vapor of chloroform by any of the modes in 
use, it should not be forgotten that it has a density and weight four 
times those of air, and that, consequently, when a cloth or handker- 
chief is held closely over the mouth, the air is displaced, and the pa- 
tient may be breathing little more than chloroform-vapor. During 
the administration of ether, attention should be directed to the state 
of the respiration, for arrest of the respiratory movements is the only 
source of danger. When chloroform is being inhaled, the state of the 
circulation, as well as of the respiratory apparatus, must be regarded. 

Means of removing Dangerous Symptoms. — Suspension of the 
heart's action is to be met at once by the withdrawal of the vapor, 
and the inversion of the patient, according to the method of Nelaton ; 
failure of respiration, by forcibly drawing out the tongue, by the 
practice of artificial respiration, and by faradization of the respiratory 
muscles. Artificial warmth should be applied, and cooling of the body 
by cold-water douche, etc., should be prohibited. Acupuncture of the 
heart, galvano-puncture, injection of ammonia into the veins, are meas- 
ures which have been used in extreme cases, but unfortunately rarely 
with success. Amyl nitrite, by inhalation or subcutaneously, has 
proved very useful in some cases. Schirmer arouses patients by irri- 
tating the nasal mucous membrane by means of a roll of paper of suit- 
able size, and this may be #nade more exciting by dipping the end in 
aqua ammonia. Alcoholic stimulants — whisky or brandy — have often 
been used nypodermatically with asserted advantage. At the present 
time the subcutaneous injection of ether is the popular expedient. It 
is, however, very questionable whether the administration of alcohol 
or one of its derivatives can be useful in a condition of things brought 



AESTHETICS. 501 

about by an anaesthetic of alcoholic origin. The author believes, in- 
deed, that serious mischief is done by this practice in cases capable of 
resuscitation. 

In practicing resuscitation for arrest of breathing due to ether, 
artificial respiration by the method of Silvester, faradization of the 
chest-muscles, and inversion of the body by the method of Nelaton, 
are the most promising expedients. 

Therapy. — Anaesthetic agents are used to quiet pain and spasm 
from disease, to render the dressing of injuries and surgical operations 
painless, and to produce muscular relaxation. Ether-inhalations give 
entire relief to the pain of neuralgia (tic-douloureux), cancer, and in- 
flammation ; to pain dependent on spasms — tetanus, chorea, hepatic 
and nephritic colic, etc. It is not necessary in these cases, as a rule, 
to induce full anaesthesia, for, as has already been pointed out, the 
sensibility to pain ceases before the condition of insensibility is reached 
— before, indeed, the perceptive centers of conscious impressions are 
otherwise impaired than as to the appreciation of pain. Paroxysms of 
maniacal delirium, and of puerperal mania, when violent and uncon- 
trollable, are sometimes quickly quieted and refreshing sleep obtained, 
from which the patient eventually arouses in a calmer frame of mind. 
Ether is the proper agent for this purpose. It should not be forgotten 
that anaesthetics are dangerous in delirium tremens. 

In puerperal convulsions due to reflex irritation, or to urcemia, the 
use of chloroform is invaluable. It is equally effective in the reflex con- 
vulsions of early life, in the urazmic convulsions of scarlet fever, and 
in the so-called hystero-epilepsy. When puerperal or other forms of 
convulsive seizures are due to cerebral haemorrhage, no good can be 
accomplished by anaesthetic inhalations. In any case, although con- 
vulsions may be arrested by anaesthetic inhalations, other appropriate 
measures must be resorted to for the permanent removal of the causes. 
A paroxysm of epilepsy impending may be aborted by the inhalation 
of ether, but the nitrite of amyl is a more effective remedy for this 
purpose. 

In certain neuroses of the respiratory organs, great relief is ob- 
tained by anaesthetic inhalations. Laryngismus stridulus may be 
quickly cured by the vapor of chloroform. A few drops of chloroform 
on a handkerchief will suffice, and special care should be taken to dilute 
the vapor largely with air. A similar procedure will relieve severe 
paroxysms of whooping-cough, but a more energetic use of chloroform 
is required when convulsions occur during a fit of coughing. Xo single 
agent gives more relief in asthma, but, like all other remedies for this 
disease, the power of relief declines, and increasing doses of the anaes- 
thetic become necessary, so that the habit of chloroform or ether nar- 
cosis is formed. 

Anaesthetic inhalations should not be recommended in cases which 



502 CEREBRAL SEDATIVES. 

will probably require their use for a long time, because the inclination 
for this kind of intoxication grows rapidly, and is as difficult to control 
as the opium-habit. The author has seen one case in which the patient 
consumed a pound of chloroform daily, but, as might be expected, this 
extraordinary consumption of the anaesthetic did not long continue, for 
the patient succumbed in a few months. 

In obstetric practice the applications of anaesthetics are numerous 
and important. The indications and contraindications for chloroform 
in natural labor may be f ormularized as follows : When the labor is of 
short duration, and not excessively painful, anaesthetics should not be 
used ; on the other hand, when the labor is protracted and the suffering 
great, they favor the progress of the case and prevent exhaustion and 
uterine inertia. In primipara caution is necessary. The inhalation of 
the anaesthetic should not begin until near the close of the first stage, 
unless those painful but ineffectual contractions occur which have been 
aptly characterized as "nagging pains," when the vapor, very much 
diluted, may be cautiously inhaled for their relief. The inhalation 
should be practiced only during the existence of the pain. The influ- 
ence of the anaesthetic on the pulse, respiration, and uterine contrac- 
tions, should be carefully observed, and, if the pulse fail, the respirations 
become shallow, or the pains lose in efficiency, the inhalation should be 
discontinued. If the anaesthetic cause great excitement, and the patient 
become loudly clamorous for more, while the uterine contractions are 
lessening in force, it is doing harm and should be withdrawn. It is 
never necessary, nor proper, to administer the anaesthetic to complete 
unconsciousness. Toward the close of the second stage, when the head 
begins to distend the external parts, the quantity of chloroform may be 
somewhat increased, but the inhalation should be discontinued when 
the occiput has passed under the pubic arch. If these rules are fol- 
lowed, the action of the anaesthetic is beneficent. Properly adminis- 
tered, the use of chloroform may be considered perfectly safe in the 
parturient female. It is generally conceded that no well-authenticated 
case of death from the use of chloroform in labor has occurred, when the 
administration was in the hands of a properly-qualified medical man. 

The following evil results, the author believes, have followed the 
incautious use of anaesthetics in labor : the progress of the case arrested, 
so that forceps became necessary ; slow and imperfect uterine contrac- 
tions, and consequent post-partum haemorrhage ; a toxic condition of the 
mother's blood, with after - excitement, wakefulness, and puerperal 
mania ; asphyxia of the child, tedious convalescence, and subinvolution 
of the womb. 

When instrumental delivery is required, the utility of anaesthetics 
is unquestionably great. It facilitates the necessary manipulations, and 
prevents shock. The inhalation should be carried far enough in these 
cases to produce sufficient quietude in the patient, and it may be to 



ANAESTHETICS. 503 

complete muscular resolution. When turning is to be performed, the 
state of chloroform narcosis must be deep enough to suspend uterine 
contractions. 

If puerperal convulsions occur at any stage, the utility of chloro- 
form is unquestionable. The limits of its utility in these cases have 
already been indicated. 

When careful examination of the pelvic viscera is to be made to 
establish the diagnosis in difficult and obscure cases, as, for example, 
phantom tumor, ovarian and fibroid growths, pelvic abscess, etc., the 
importance of full anaesthesia can hardly be over-estimated. 

The use of anaesthetics in operative surgery is now an indispensable 
practice. It may be compendiously stated that ether, or chloroform, 
is required in all surgical operations of magnitude, for the reduction of 
dislocations, for the taxis in strangulated hernia, for dressing painful 
toounds and adjusting fractures, for breaking up adhesions, and con- 
tractions of muscles and tendons in cases of deformity, for establishing 
the diagnosis in feigned diseases, etc. 

The after nausea and vomiting, which are sometimes most depress- 
ing, and occasionally dangerous, produced by anaesthetics, may be pre- 
vented by the hypodermatic injection of morphine and atropine before 
beginning the administration of the anaesthetic. After the patient 
emerges from the anaesthetic sleep, the above-mentioned unpleasant 
after-effects may be relieved by a minute quantity of morphine (y 1 ^ of 
a grain) and atropine (y|-g- of a grain) injected subcutaneously. 

Comparative Utility of Ether and Chloroform. — Chloroform 
is more pleasant to inhale, and is less irritant to the air-passages than 
ether. The vapor of chloroform is not, and the vapor of ether is, in- 
flammable, whence it follows that the former may be alone admissible 
at night under some circumstances. The stage of excitement is longer 
from ether than from chloroform, but, as ether may be given much 
more rapidly, this difference in action may be made to disappear in 
practice. Chloroform is more prompt in its effects, and the narcosis 
induced by it more sustained, than is the case with ether ; but these 
advantages possessed by chloroform are quite balanced by the greater 
freedom with which ether may be administered. The danger from 
the inhalation of chloroform is vastly greater than from ether. 

It folloics from the above considerations that ether should be used 
in preference to chloroform in all cases, except during labor. Chloro- 
form is to be preferred in labor, because more pleasant to inhale, more 
prompt in action, and without inflammability. The consideration of 
safety must necessarily take precedence, but experience has shown 
that chloroform is perfectly safe in labor when properly administered. 

The frequency with which fatal cases of chloroform narcosis have 
been reported — amounting in the aggregate now to about five hun- 
dred — imposes an immense responsibility on the administrator. In the 



504 CEREBRAL SEDATIVES. 

present state of opinion on the subject, the use of chloroform, when 
ether is available, for the production of anaesthesia, can hardly be jus- 
tified, especially if a fatal result follow its administration. 

Ethyl Bromide. — The physical properties of this ether are men- 
tioned on another page in connection with ether. As an anaesthetic, 
it was first known to Mr. Nunnely, of Leeds, and he first employed it 
in surgical practice in 1865. Dr. Turnbull gave an account of its prop- 
erties, based on experimental and clinical evidence, in 1877, but the 
most extended trials of its anaesthetic powers were made by Dr. Levis, 
of Philadelphia, in 1879-'80. In the latter year two unsuccessful 
cases occurred, one in the hands of Dr. Levis, its chief promoter, and 
the other in the practice of Dr. Marion Sims, of New York. These 
fatal cases, and some crude physiological experiments, undertaken to 
prove that ethyl bromide is a heart-paralyzer, started a reaction against 
this anaesthetic, then beginning a promising career, and in a short time 
it fell into almost complete disuse. It has, however, valuable properties 
which should preserve it from neglect. To induce complete insensi- 
bility, from four to six grammes ( 3 j — 3 jss) must be administered rap- 
idly. The odor is not unpleasant, and but little irritation of the air- 
passages is produced. If administered in full quantity, there is a very 
brief (scarcely noticeable) stage of excitement, and the period of rigid- 
ity is very short and not pronounced. The face is flushed, the ears 
red, the eyes injected, and the pupils are more or less dilated. The 
action of the heart is accelerated, and the pulse increases in force. 
The respiration is also somewhat quickened, and in some subjects be- 
comes snorting or stertorous, but irregularity or arrest of the respira- 
tory movements has not occurred. More or less embarrassment of 
breathing has been occasionally caused by an accumulation of bron- 
chial mucus. It does not often induce nausea and vomiting ; but 
women are more apt to be disturbed in this way than men. The du- 
ration of the stage of insensibility is brief and the awakening prompt, 
with little of the confusion of mind and excitement characteristic of 
ether and chloroform. As a rule, the patient wakes out of the anaes- 
thetic condition with little distress of any kind. 

In the fatal cases recorded, there are strong doubts in regard to 
the share of ethyl bromide in the result. In Dr. Levis's case the pa- 
tient was far advanced in pulmonary disease, and was unfit for the 
administration of any anaesthetic. In Dr. Sims's case the death of the 
patient occurred a number of hours after the operation, which was a 
tedious one, requiring very protracted use of the anaesthetic. It is said 
that a strong odor of bromine pervaded the entire body of this sub- 
ject. It is, however, in a high degree improbable that decomposition 
of the ethyl bromide takes place when it is inhaled. 

In administering this anaesthetic the method pursued with ether is 



ANESTHETICS. 505 

best. If given promptly, in sufficient quantity, and but slightly di- 
luted with air, the stage of insensibility can be induced in about five 
minutes (Levis). It is not suited to operations requiring much time. 
It is, however, peculiarly well adapted for slight or brief operations 
of a very painful character, and for ophthalmic practice it is unequaled, 
according to Chisolm. 

M. Perier states that he has used ethyl bromide very often as a 
local anaesthetic, instead of ether, and, he affirms, with great success. 
The method to which he refers is local anaesthesia as inaugurated by 
Richardson with the spray -douche. Among other distinct advantages 
over ether, ethyl bromide is not inflammable, and can consequently be 
used under circumstances prohibiting the former. 

The inhalation of ethyl bromide has been utilized in the treatment 
of diseases for the relief of which the bromides have been given by 
the stomach. MM. Bourneville and Oilier have carefully investigated 
this action of ethyl bromide in hysteria and epilepsy. They find that 
hysterical seizures are promptly arrested, and that in epilepsy the 
daily administration of this remedy during a period of two or three 
months notably diminishes the frequency of the attacks. This prac- 
tice might be advantageously extended to the treatment of severe chorea, 
ichooping -cough, spasmodic asthma, hepatic and renal colic, etc. For 
these purposes, only sufficient ethyl bromide is inhaled to relieve the 
pain or spasm, or to induce sopor. 

Bichloride of Methylene. — This agent, similar to chloroform, was 
first proposed as an anaesthetic by Dr. B. W. Richardson. It is more 
agreeable to inhale, and less apt to produce after-sickness, than chloro- 
form, but it is not less, and probably more, dangerous to life. Five or 
six deaths have occurred in the cases in which methylene bichloride 
was administered. Spencer Wells has constantly used it since it was 
introduced, without a single untoward result. But he employs a spe- 
cial administrator, and gives the vapor with a regulated supply of air. 
His apparatus consists of a mask closely fitting over the mouth and 
nose, connected by a flexible tube with a bottle containing the anaes- 
thetic, and with a rubber hand-ball, which sends into the mask, with 
every contraction of the bulb by the hand, this quantity of air with 
the anaesthetic vapor. As no accidents have happened, and yet pa- 
tients are kept narcotized for hours at a time, there can be no doubt 
of the security afforded by this method of conducting the inhalation. 
It were well if this plan were applied to the inhalation of chloroform 
as well as bichloride of methylene. 

Authorities referred to : 

Anstie, Dr. Francis Edmund. Stimulants and Narcotics, American edition. 
Aubert, Dr. M. P. Anesthesies mixtes par V ether, la morphine et V atropine. Lyon Medi- 
cate, January 14, 1883. 



506 CEREBRAL SEDATIVES. 

Boettcher, Prof. Dr. A. TJeher die Wirkung des Chloroforms auf das Blut. Vir- 
chow's Archiv, xxxii, 1865, p. 126. 

Brinon, de, Dr. H. Anesthesie mixte par le chloroforme et la morphine. Ann. de 
Therap., 1879. 

Gubler, Dr. A. Commentaires Tlierapeutiques du Codex Medicamentarius, etc., p. 670. 

Husemann, Dr. Theodor. Handbuch der gesammten Arzneimittellehre, zweiter Band, 
p. 1034. 

Kohler, Dr. Hermann. Chloroform, Aether und die als Ersatzmittel des Chloroform 
empfohlenen Alkoholderivate zusammengestelle und besprochen. Schmidfs Jahrbucher, vol. 
cxlii, p. 209, and vol. cxlv, p. 305. 

Lente, Dr. Frederic D. Neio York Medical Journal, vol. viii, p. 615. 

Medico-Chirurgical Transactions. Report of the Committee, etc., to inquire into the 
Uses and the Physiological, Therapeutical, and Toxical Effects of Chloroform, etc, vol. 
xxix, second series, p. 323. 

Morgan, Dr. J. The Danger of Chloroform and the Safety and Efficiency of Ether, 
London, 1872. 

Nothnagel, Dr. Hermann. Die fettige Degeneration der Organe bei Chloroformvergif- 
tung. Berliner Jclinische Wochen., iii, 4, 1866. 

Ibid. Handbuch der Arzneimittellehre, p. 125. 

Petrequin, Dr. J. E. Nouvelles Recherches sur la Choix d faire entre la Chloroforme 
et V Ether red., etc. * Gaz. Heb., 4-6, 1867. 

Reeve, Dr. J. C. American Journal of Medical Sciences, October, 1867. 

Richardson, Dr. B. W. The Medical Times and Gazette, 1866-1871, various articles. 

Sansom, Dr. Arthur Ernest. Chloroform : Its Action and Administration, Phila- 
delphia, 1866. 

Simpson, Sir J. Y. Anaesthesia, Hospitalism, etc., Works, American edition. 

Snow, Dr. On Chloroform and other Anaesthetics, London, 1858. 

Squibb, Dr. E. R. New York Medical Journal, April, 1871. 

Trousseau et Pidoux. Traite de Therapeutique et de Matiere Medicale, eighth edition, 
vol. ii, p. 301. 

Verriet-Litardiere, Dr. These de Paris, 1879. Anesthesie mixte par le chloroforme 
et la morphine. 

Authorities for ethyl bromide : 

Chisolm, Prof. J. J., M. D. Maryland Medical Journal, vol. ix, No. 32. 

Duval, Dr. M. A. These de Paris, 1881. Bromure d'ethyle comme anesthesique. 

Levis, Dr. R. Ethyl Bromide as an Anaesthetic. The Medical Record, New York, 
March 27, 1880. 

Nunnely, Mr. Thomas. Transactions of the British Medical Association for 1865. 

Perier, Dr. Annuaire de 1 her apeutique pour 1881, p. 62. 

Terrillon, Dr. Bromure d'ethyle comme ancesthesique. Annuaire de Therapeutique 
pour 1881. 

Turnbull, Dr. L. Artificial Anaesthesia, Philadelphia, 1882. 

Local Anaesthesia. — The diminution of the cutaneous sensibility, 
by the application of ice and freezing mixtures, has long been practiced. 
It was not, however, until Richardson's method by the hand-ball spray 
apparatus had been proposed, that there had been much use made of 
local anaesthesia. 

This method consists in directing a current of atomized ether 
against the part to be anaesthetized. The ether employed for this 



NITROUS OXIDE. 507 

purpose should have a specific gravity not to exceed 0*723. Rhigolene, 
the lightest liquid known, a product of the fractional distillation of 
petroleum, is more effective than ether, but great difficulty attends its 
use, owing to its extreme volatility. When a current of atomized 
ether or rhigolene is directed against the skin, the rapid evaporation 
produces an intense degree of cold, in consequence of which the nerves 
lose their power of transmitting impressions to the sensorium. 

A serious drawback to the process of producing local anaesthesia 
is the unpleasant burning which follows in the part when it recovers 
from the freezing, and also the great pain which attends the applica- 
tion of ether-spray to certain parts. 

Therapy. — For small operations, such as extraction of teeth and 
ope?iing abscesses, the method of local anaesthesia is extremely useful. 
It has been and can be used with entire success in much larger opera- 
tions, but it is generally employed for merely minor ones. 

The application of ether-spray to the spine is an extremely service- 
able remedy in spinal irritation and in chorea. In the latter disease 
it alone suffices to effect a cure. In neuralgia of superficial nerves, 
lumbago, muscular rheumatism, etc., the ether-spray affords relief very 
quickly, which may be permanent. 

Nitrous Oxide. — Protoxide of nitrogen. Laughing-gas. 

Composition and Properties. — A colorless, inodorous gas, having 
a slightly sweetish taste, and a specific gravity of 1*527. It consists 
of one equivalent each of nitrogen and oxygen. It increases the rate 
of combustion of inflammable substances. Water at ordinary temper- 
ature absorbs about three fourths of its bulk of the gas. By pressure 
and cold the gas may be condensed into a liquid, and can then be stored 
up in suitable vessels for transportation and use. The quantity of the 
gas taken up by cold water may be much increased by pressure, and 
the water will then yield it up on heating. Hence this constitutes a 
convenient mode of storing the gas for preservation. The ordinary 
mode of storing the gas is in gas-bags holding about eight gallons, in 
gasometers, or in the liquid form in strong metallic casks. 

Physiological Actions. — The first surgical operation performed 
with a modern anaesthetic was the extraction of a tooth, the subject 
being unconscious from the inhalation of nitrous oxide. It had long 
been known that this gas produced decided exhilaration when inhaled 
to a certain point. It has a very short anaesthetic stage, unless the in- 
halation of the gas be continued. 

The first effect of the inhalation of nitrous oxide is a subjective 
dizziness, whirring noises in the ears, and tingling and loss of sensa- 
tion throughout the body. Extraordinary illusions beguile the senses, 
and the intoxicated subject suddenly breaks forth into singing, decla- 
mation, sobbing, melancholy, or manifests a pugnacious tendency and 



508 CEREBRAL SEDATIVES. 

assaults those about him. As the effects quickly cease, and as the 
return to consciousness is very abrupt, the subject is surprised and 
ashamed to find himself in some ridiculous or grandiose position quite 
foreign to his usual demeanor. 

When used to produce anaesthesia for surgical operations, the inha- 
lation of the gas is forced, and the stage of excitement is very brief. 
The countenance assumes a frightful aspect, most alarming to those 
who have not witnessed the inhalation of the gas. The face becomes 
deadly pale, the respirations, at first shallow, soon assume a stertorous 
character, the jaw becomes fixed, the eyes protrude, and the pallor of 
the face is presently replaced by a bluish and purplish tint. 

So far as the exterior phenomena can afford any indication of the 
nature of the action, the condition produced by nitrous oxide is an 
asphyxiated state. The blood ceases to be oxygenated, carbonic acid 
accumulates, and the centers of conscious impressions are rendered in- 
active in consequence of the deficient supply of oxygen and the excess 
of carbonic acid. The rational indications of the nature of the narcosis 
produced by nitrous oxide are confirmed by physiological experiment. 
It has been found that the exhalation of carbonic acid is decidedly 
diminished by the inhalation of nitrous oxide, and that animals live no 
longer in an atmosphere of this gas than in an atmosphere of nitrogen. 

The inhalation of nitrous oxide appears to be almost free from 
danger, and it is rare that unpleasant after-effects follow its adminis- 
tration. Two fatal cases have certainly occurred, which can with pro- 
priety be attributed to the lethal action of this gas, and various cases 
have fallen under the observation of the author in which nervousness, 
vague mental symptoms, and headache, have been experienced after 
the inhalations. 

Therapy. — The very prompt action of nitrous oxide and the quick 
subsidence of the narcosis render it a very useful anaesthetic agent 
when small operations, quickly executed, are to be performed. It is 
especially adapted for the extraction of teeth, opening of abscesses, and 
similar minor operations. But it has also been used successfully for 
maintaining prolonged anaesthesia for the performance of capital oper- 
ations. There is no difficulty in keeping up insensibility from fifteen 
minutes to a half -hour, since the introduction of liquefied gas and of 
apparatus for its suitable application. 

Authorities referred to : 

Amory, Dr. Robert. The Physiological Action of Nitrous Oxide. New York Medical 
Journal, August, 18*70. 

Johnson, Dr. George. A Lecture on the Physiology of Coma and Anaesthesia. Medi- 
cal Times and Gazette, April 3, 1869. 

Jolyet et T. Blanche, MM. Recherches experimental sur V Action du Gaz protoxyde 
d" 1 Azote. Bulletin General de Therap., vol. lxxxv, p. 91. 

Richardson, Dr. B. W. Medical Times and Gazette, vol. i, 1868. 



CHLORAL. 509 

Chloral. — Chloral. Hydrate of chloral. Chloral, Fr. ; Chloralhy- 
drat, Ger. 

Separate, rhomboidal, colorless and transparent crystals, slowly 
evaporating when exposed to the air, having an aromatic, penetrating, 
and slightly acrid odor, a bitterish, caustic taste, and a neutral reaction. 
Freely soluble in water, alcohol, or ether ; also soluble in four parts of 
chloroform, in glycerin, benzol, benzin, disulphide of carbon, fixed or 
volatile oils. It liquefies when mixed with carbolic acid and camphor. 

Dose, grs. v — 3j, or more, but it should not be forgotten that 3 ss 
has produced toxic symptoms. 

Antagonists and Incompatibles.- — The depression of the heart 
and respiration caused by chloral is antagonized by alcoholic stimu- 
lants, ammonia, atropine, by galvanism, and by artificial heat. These 
are, therefore, appropriate remedies to be employed in cases of poison- 
ing. Strychnine is held by Liebreich to be antagonistic, and hence it 
may be administered hypodermatically when the measures above men- 
tioned are being used. 

Alkalies decompose chloral with the production of formic acid and 
chloroform, hence all agents having an alkaline reaction are incompat- 
ible. 

Synergists. — The hypnotic medicines, notably opium, and the an- 
aesthetics, deepen the effects of chloral when they are simultaneously 
administered. 

Physiological Actions. — Chloral has considerable antiseptic prop- 
erty, and is preservative of animal textures. It produces redness and 
inflammation of the skin, when kept in contact with it for a lengthened 
period. The taste of chloral is hot and pungent, and it excites an 
abundant flow of saliva. In the stomach it causes first a cooling sen- 
sation, followed by warmth, and when taken in large quantity may set 
up a high degree of. gastric irritation, nausea, and vomiting. In mod- 
erate quantity chloral rather stimulates than impairs the appetite, and 
indigestion and nausea do not, as a rule, follow as an after-effect. 

Chloral diffuses into the blood rapidly. The changes which occur 
after its entrance into the vessels are much disputed. Liebreich, as is 
well known, was led — by observing the reaction when chloral is brought 
into the presence of an alkali — to the deduction that the soda of the 
blood would split up chloral into chloroform and formic acid, and that, 
therefore, the effects belonging to chloroform might be produced by the 
administration of chloral. It is probably true that this reaction does 
take place to some extent, but there are several insuperable objections 
to the theory of Liebreich : 

1. The effects of chloral differ from those produced by a corre- 
sponding quantity of chloroform. 

2. After the administration of chloral, there is no elimination of 
chloroform by the breath or urine. 



510 CEREBRAL SEDATIVES. 

3. Chloral is more decidedly hypnotic, and much less anaesthetic, 
than chloroform. 

4. Crystals of chloral have been recognized in the blood, and the 
products of the decomposition of chloral have recently been recovered 
from the urine. 

The effects which follow an ordinary medicinal dose (fifteen to 
thirty grains) are not the same in all subjects, although it must be 
admitted that a great degree of uniformity exists. When there is 
present an insusceptibility to its hypnotic action it produces headache, 
and in some subjects a delirious excitement. Immediately preceding 
its hypnotic action there is developed in all subjects a stage of excite- 
ment, usually very short in duration, and followed by sudden and 
complete sopor. The sleep produced by chloral is extraordinarily 
like natural sleep, and is calm, dreamless, and refreshing. It is not a 
condition of narcotism, and the patient may be easily aroused to take 
food and nourishment, and will quickly and without difficulty fall 
asleep again. As a rule no unpleasant after-effects are experienced 
from a dose of chloral — no headache, faintness, giddiness, nausea, and 
constipation, so common after morphine. The quantity of chloral ne- 
cessary to produce sleep, without dangerous narcotism, ranges from 
fifteen to forty grains, and the duration of the effect varies in differ- 
ent subjects from two to eight hours. Chloral does not destroy the 
sensibility to pain, unless administered in a quantity sufficient to sus- 
pend the functions of the cerebrum. It is not a pain-relieving agent 
in the sense that morphine is. 

When sleep is produced by proper medicinal doses of chloral the 
pupil contracts a little, the pulse may remain unaltered or become 
slower, and the respirations are unaffected. When a dangerous or 
lethal dose is taken, profound narcotism will follow ; the respirations 
will be slower and shallower, the pulse will become weak, rapid, and 
irregular ; sensibility and the reflex movements will be abolished, and 
complete muscular relaxation will ensue. The mode of dying is by 
suspension of the functions of the cerebrum, and, finally, by paralysis 
of the respiratory center, and of the cardiac motor ganglia. Death 
may be suddenly produced by paralysis of the heart, in cases of fatty 
degeneration of the muscular tissue of this organ, without proceed- 
ing so far as to involve the lower centers of the brain. 

A marked reduction in temperature, notably in rabbits — so much 
as 8° Fahr. — is produced by chloral, but this effect may be considera- 
bly lessened by enveloping the body in non-conductors (Brunton), 
which act by preventing the cooling of the blood by the atmosphere. 
The first effect of chloral is to raise the arterial tension (stage of 
excitement), but this action quickly ceases, and a decided lowering of 
the tension results. The diminished arterial tension and the weak- 
ened action of the heart are the principal factors in the reduction of 



CHLORAL. 511 

the body temperature, for the combined action of these agencies is to 
lessen the combustion process. After death from chloral, congestion 
of the meninges of the brain and cord, of the lungs, and distention 
of the right cavities of the heart, have been observed. The arrest 
of the heart's action takes place in the diastole. 

Chloral does not affect the motor nerves nor impair the contrac- 
tility of muscle ; hence the paralytic phenomena both of animal and 
of organic life produced by it are due to its direct action on the 
nervous centers. 

Very large quantities of chloral have been taken without pro- 
ducing fatal symptoms. I have seen a patient who took daily from 
two drachms to three drachms of chloral for many months, without 
any symptoms of acute poisoning. While it is true that enormous 
doses (several hundred grains) have been taken without producing 
lethal effects, it is equally true that serious symptoms and death have 
resulted from very moderate doses (twenty to thirty grains). Great 
care should therefore be taken in prescribing an agent of such uncer- 
tain power. A fatty heart, atheromatous degeneration of the vessels, 
advanced disease of the lungs, and instability of the nervous system, 
are contraindications of the use of chloral. 

Chloeal-Habit. — The habitual use of chloral constitutes a dis- 
order, which, if not as persistent as the opium -habit, has its own 
difficulties and dangers of no little importance. Those who take 
choral habitually have irritable, injected, and rather brilliant eyes, and 
are voluble in speech, and have a rather excited and hurried manner. 
They complain usually of singing in the ears, of an empty or vacuous 
feeling in the brain, and are subject to sudden attacks of vertigo. 
They are wakeful, and very nervous and excitable, without chloral, 
when the time for sleep arrives, and they are usually entirely unable 
to sleep without the usual dose of the hypnotic. During the day they 
are melancholy, easily fatigued, and their voluntary movements are apt 
to be uncertain and disordered. The appetite is always capricious, 
frequently wanting ; digestion is labored ; the secretion of bile is de- 
ficient, the stools being rather white and pasty ; the urine stained with 
the bile-elements, and sometimes albuminous. 

An increasing weakness and irregularity in the action of the heart ; 
dyspnoea, chiefly when the stomach is distended ; redness, injection, 
and ecchymoses of the skin, have been occasionally observed to occur 
in cases of the chloral-habit. 

The best method of managing these unfortunate cases consists in 
the very gradual diminution of the daily quantity of chloral ; in regu- 
lation of the diet and administration of a suitable supply of food ; air, 
exercise, and change of scene ; chalybeate tonics ; hyoscyamus and 
lupuline as calmatives, strychnine and picrotoxin as nerve stimulants ; 
occasional purgatives. 



512 CEREBRAL SEDATIVES. 

Therapy. — Chloral is a remedy of great value in sea-sickness. 
From fifteen to thirty grains every four hours, the recumbent posture 
for a short time, and suitable nourishment, are the most effective means 
we now possess for this troublesome disorder. In some cases of sick- 
ness of pregnancy chloral is equally effective, but, like other remedies 
for this condition, it often fails. According to the author's observation, 
it is most effective when there is much dizziness, faintness, and repug- 
nance to food, and but little vomiting. When the odor of chloral 
invites nausea, as is not unfrequently the case, it may be given advan- 
tageously by enema. And, furthermore, rectal injection of fifteen to 
thirty grains, properly diluted, is an effective remedy for nausea and 
vomiting of reflex origin, as occur in cases of uterine fibroids, gastro- 
enteritis of children (Kjelberg), etc. 

In severe cases of cholera-morbus, with cramps, coldness of the sur- 
face, cold breath and cold tongue, remarkable relief is procured, and 
the patient not unfrequently wrested from a condition of extreme dan • 
ger, by the hypodermatic injection of chloral. There is no means of 
treatment of cholera now known so effective as this, as the author has 
personally witnessed. The effectiveness of chloral is increased by com- 
bination with morphine. I£ Chloral, hydratis, 3 iij ; morphinse sulph., 
gr. iv ; aquae laur.-cerasi, § j. M. Sig. : From fifteen to thirty minims 
— -for cholera, cholera-morbus, etc. This injection produces consider- 
able burning pain and an indurated lump, but in the author's expe- 
rience suppuration has not followed. 

As chloral produces a lowering of the temperature, and, according 
to Richardson, diminishes the coagulability of the fibrin, good results 
may be expected from its use in inflammations and fevers. It is es- 
pecially indicated when the temperature is high and there are much 
delirium and restlessness present. The author has observed excellent 
results from its use under these circumstances in the eruptive fevers, 
pneumonia, etc. It should not be forgotten, however, that chloral 
must be prescribed with caution when there is ischsemia of the arterial 
system — a condition which must necessarily exist when a considerable 
portion of the lung-space is blocked up by fibrinous or caseous de- 
posits. In pleuritis, endo- and pericarditis, and in peritonitis, much 
good will result from the use of moderate doses of choral — five grains 
every three hours. It is useful because it allays restlessness, causes 
sleep, lowers the fever, and limits or prevents fibrinous deposits and 
exudations. 

The most important uses of chloral are in diseases of the nervous 
system. As an hypnotic, pure and simple, it is quite unrivaled. Cases 
of sleeplessness, due to mental overwork, anxiety, or physical fatigue, 
are entirely relieved by fifteen to twenty grains of chloral. The re- 
freshing sleep thus obtained not unfrequently leads to repeated and 
long-continued use of chloral, and thus the chloral-habit is formed. It 



CHLORAL. 513 

follows that sleep should be procured by proper hygienic methods in 
such cases, if possible, and chloral should be resorted to only after the 
failure of such means. No hypnotic is so uniformly successful in pro- 
curing sleep in delirium tremens ; but this remedy, as other remedies of 
the same class, not unfrequently fails. It is more particularly adapted 
to those cases in which the delirium has succeeded to a debauch, and 
is less useful, and may, indeed, produce serious symptoms, in old, worn- 
out drunkards. Violent excitement not unfrequently is produced by 
it when it fails to cause sleep. The author must caution his younger 
readers against the too large administration of chloral in this disease. 
Sleep may be procured which will end in fatal exhaustion. Especially 
should caution be used in the old drunkard, whose heart and vascular 
system may have undergone serious fatty and calcareous degeneration. 
In suitable cases there is no doubt chloral is a remedy of the highest 
value, but it should not be used to the exclusion of suitable hygienic 
and dietetic treatment. 

Various forms of mania, in which delirium and wakefulness are 
prominent symptoms, are largely benefited by hypnotic doses of 
chloral. This remark is true of acute mania, acute melancholia, 
puerperal mania, acute maniacal delirium, and the excitement which 
occurs in general paralysis of the insane. When it agrees, and pro- 
duces refreshing sleep, marked improvement in the mental state not 
unfrequently follows its use. In incurable and intractable cases, 
chloral often renders the greatest service as a calmative and an 
hypnotic. 

Puerperal convulsions, when the patient is in a condition to swal- 
low, may be arrested by full doses of chloral — twenty grains every 
two hours ; also, subcutaneously in five-grain doses, it is highly effec- 
tive, according to Purefoy, and by the rectum its acts admirably in 
many cases. Infantile convulsions, when due to reflex irritation, may 
be suspended by the same means. When the jactitations of chorea 
are so incessant as to prevent sleep, or when they occur during sleep, 
chloral may be administered with advantage. It is not a curative 
agent in chorea, but when it produces quiet and refreshing sleep it 
indirectly contributes to the cure. 

Some of the respiratory neuroses are greatly benefited by chloral. 
The paroxysms of spasmodic asthma may be arrested by it, and the 
spasmodic attacks of difficult breathing which accompany emphysema 
may be decidedly ameliorated by timely doses of chloral. It must not 
be forgotten, however, that the use of chloral is not unattended with 
danger in pulmonary diseases with ischsemia of the arterial system. 
In the spasmodic stage of whooping-cough, great relief to the parox- 
ysms maybe obtained by the use of this agent. From five to ten 
grains will generally be a suitable quantity for administration in these 
cases. Impending attacks of laryngismus stridulus may be prevented, 
33 



514 CEREBRAL SEDATIVES. 

and seizures already in action can be quickly arrested, by a full dose 
of chloral — five to fifteen grains. 

We have no remedy more effective in tetanus than chloral, but it 
must be given in large doses. Nocturnal attacks of epilepsy may not 
unfrequently be prevented by a full dose of chloral at bedtime. In 
paralysis agitans, good effects have been attained by hypnotic doses 
at bedtime. Chloral is a physiological antagonist to strychnine, and 
may, therefore, be used with advantage in poisoning by this substance. 

Chloral is not unfrequently prescribed to relieve pain, but under a 
mistaken notion of its physiological powers. It can only relieve pain 
by suspending the functions of the cerebrum, and in doses, therefore, 
which are dangerous. It has no direct pain-relieving power, like mor- 
phine. When pain is to be relieved and sleep procured, the combina- 
tion of chloral and morphine is extremely effective. Although chloral 
does not directly suspend the functions of the sensory nerves, it relieves 
certain kinds of pain due to irregular or overaction of un striped mus- 
cular fibers. Yery great relief is afforded by chloral to the irregular 
pains of the first stage of labor, which cause suffering but do not ad- 
vance the case — the so-called "nagging pains," in popular obstetric 
language. Rigidity of the os uteri and soft parts may be corrected 
by the timely administration of chloral, and exhaustion may be pre- 
vented by giving it in such a way as to suspend irregular uterine 
action and to procure sleep. After-pains are stopped by chloral. In 
all these cases of obstetric diseases, large doses are generally required. 

A solution of chloral is an excellent antiseptic application to foul 
wounds: it destroys the odor of putrefaction, arrests fermentative 
changes, and promotes the formation of healthy granulations. It may 
be used to preserve anatomical preparations and morbid specimens. 
A weak solution of chloral (gr. j to grs. iv — § j) is an excellent in- 
jection in gonorrhoea. 

Equal parts of chloral and camphor, triturated together, form a 
clear fluid, which is often of great service in neuralgia, applied to the 
affected part. It is painted lightly over the surface with a camel's- 
hair brush, and is allowed to dry on. It is said to allay spasmodic 
cough when painted over the larynx. The solution of camphor and 
chloral thus prepared has decided solvent properties. Morphine sul- 
phate will dissolve in it in the proportion of a scruple to two drachms, 
and chloroform can then be added without a separation of the ingre- 
dients. A mixture thus prepared is a very effective local application 
in superficial neuralgiw, and as an internal remedy in colic, cholera- 
morbus, cholera, etc. 

Authorities referred to : 

Amory, Dr. Robert. The New York Medical Journal, vol. xv, p. 606. 
Andrews, Dr. J. B. The Physiological Action and Therapeutic Use of Chloral, Utica, 
N. Y., 187L 



CROTON-CHLORAL HYDRATE. 515 

Browne, Lennox. The British Medical Journal, March 7, 1874, p. 304. 

Da Costa, Dr. J. M. Clinical Notes on Chloral. American Journal of Medical Sci- 
ences, April, 1870, p. 359. 

Demarquay, M. Notes sur le Chloral. Bulletin de Therapeutique, vol. lxxvii, p. 307. 

Husemann, Dr." Theod. Handbuch der gesammten Arzneimittellehre, zweiter Band, 
p. 1088. 

Keen, Dr. W. W. The Anatomical, Pathological, and Surgical Uses of Chloral. 
American Journal of Medical Sciences, July, 1875. 

Liebreich, Dr. Oscar. Das Chloralhydrat, ein neues Hypnoticum und Ancestheticum, 
und dessen Anwendung in der Medicin, zweite Auflage, Berlin, 1869. 

Lange, Dr. Ueber die Wirkung des Chloralhydrat. Berliner klinische Wochenschrift, 
No. 10, 1870. 

Personne and Bouchut, MM. TJie Medical Times and Gazette, vol. xi, 1869, p. 605. 

Richardson, Dr. B. W. On the Physiological Actions of Chloral. T7ie Medical 
Times and Gazette, vol. xi, 1869. 

Reynolds, Dr. J. Russell. The Practitioner, vol. iv, p. 188, March, 1870. 

Tomaszewicz, A. Die Wirkungen des Chloral und der Trichloressigsaure. Archiv 
fur Physiologie, ix, p. 35, Mai, 1874. Schmidfs Jahrbucher, No. 8, 1874. 

Wells, Mr. Spencer. On Hydrate of Chloral and its Use in Practice. The Medical 
Times and Gazette, vol. xi, 1869. 



Croton-Chloral Hydrate. — This substance occurs in rather small and 
brilliant tabular crystals. It is soluble in water, but not freely so ; 
and, as respects antagonists and incompatibles, may be classed with 
chloral hydrate. Dose, grs. ij — grs. xv, largely diluted in water. It 
may also be conveniently made into pills with glycerite of traga- 
canth. 

Physiological Actions and Therapy. — Croton-chloral resembles 
chloral in its hypnotic action, but it is feebler and also less certain. 
As in lethal doses it causes death by paralysis of respiration, it is 
admissible in cases of weak heart. It differs from chloral, especially 
in the singular property which it possesses of causing anaesthesia of the 
head. Croton-chloral is much less certain in its effects than chloral : 
sometimes one or two grains will relieve severe trigeminal neuralgia ; 
and often from five to fifteen grains are necessary. When pain is to 
be relieved and sleep procured, the best results are obtained by a com- 
bination of the two agents. 

Croton-chloral has proved very effective in various neuralgice. It 
has been especially useful in tic-douloureux, in which it should be given 
in doses of two to five grains every hour or two, until fifteen grains 
have been taken. It is probably not safe to exceed this amount at 
one time. The pains of dysmenorrhea and sciatica have also been 
relieved by the use of this remedy. 

Authorities referred to : 

The British Medical Journal, October 30, 1873, March 7, 1874. 
Schmidt's Jahrbucher. Papers by Profs. Liebreich, Benson, Baker, and Wickham 
Legg, Band 161, p. 16. 



516 CEREBRAL SEDATIVES. 

Opium. — Opium. Opium, Fr. ; Opium, Ger. The concrete milky 
exudation obtained in Asia Minor from the unripe capsules of Papa- 
ver somniferum, by incision and spontaneous evaporation. (Nat. Ord. 
Papaveracece). (U. S. P.) 

Opium should yield at least nine per cent of morphine by the pro- 
cess of assay. 

Opii JPulvis. — Powdered opium. Opium dried at a temperature 
not exceeding 185° Fahr., and reduced to a moderately fine powder 
(No. 50). It should contain not less than twelve nor more than six- 
teen per cent of morpnine. Dose, gr. j — gr. iij. 

Opium Denarcotisatum. — Denarcotized opium. Opium freed 
from materials soluble in ether — odorous matters, narcotine, etc. It 
should contain fourteen per cent of morphine. Dose, gr. j — gr. iij. 

Emplastrum Opii. — Plaster of opium. (Extract of opium, Bur- 
gundy pitch, and lead-plaster.) 

Extr actum Opii. — Extract of opium. Dose, gr. ss — grs. ij. 

Pilulce Opii. — Pills of opium. Dose, one to four pills. Each pill 
contains one grain of opium. 

Pulvis Ipecacuanhce et Opii. — Compound powder of ipecacuanha. 
Dover's powder. Ten grains contain one grain each of ipecac and of 
opium, and eight grains of sugar of milk. 

Tinctura Opii. — Tincture of opium. Laudanum. Thirteen minims 
or twenty-five drops are equivalent to one grain of opium. 

Acetum Opii. — Yinegar of opium. Ten minims or twenty drops 
are about equal to one grain of opium. 

Tinctura Opii Camphorata. — Camphorated tincture of opium. 
Paregoric. Half a fluid ounce contains nearly one grain of opium. 
Dose, for children, from gtt. v. — gtt. xx ; for adults, from 3 j — J ]• 

Trochisci Glycyrrhizce, et Opii. — Troches of licorice and opium. 
Dose, one to three or four. 

Tinctura Opii Deodorata. — Deodorized tincture of opium. Dose, 

m v— 3 j. 

Vinum Opii. — Wine of opium. (Opium, cinnamon, cloves, sherry 
wine.) Dose, % v — 3 j. 

Composition. — About half of the weight of opium is made up 
of gum, pectin, albumen, fragments of the poppy-capsules, and cal- 
careous salts. It contains, also, some coloring-matter, and a volatile 
substance in minute quantity. The proportion of water varies from 
twelve to thirty per cent. A large number of basic, acid, and neutral 
substances have been and are still being discovered in opium, hence its 
chemistry is very complex. 

The following natural alkaloids have been found in opium. Vari- 
ous derivatives of these have also been described. This list, except 
some unimportant modifications, is taken from Fltickiger and Han- 
bury's admirable Pharmacographia : 



OPIUM. 517 

Hydrocotarnine. — Crystallizable, alkaline. Volatile at 100°. (C ia 

H„N,0,.) 

Morphine (morphina). — Crystallizable, alkaline. (C 17 H 18 N x 8 .) 
Pseudo-morphine. — Crystallizes with H a O, does not unite even 

with acetic acid. (C l ,K l9 N l O A .) 

Codeine (codeina). — Crystallizable, alkaline, soluble in water. (C IB 

H.N,O s .) 

Thebaine (thebaina). — Crystallizable, alkaline. (C^H^ISTjOg.) 

Protopine. — Crystallizable, alkaline. (C 2tf H^ 9 K 1 O s .) 

Laudamine. — An alkaloid, which, as well as its salts, forms large 

crystals. (0,^.^0,.) 

Codamine. — Crystallizable, alkaline ; can be sublimed. (C^H^Nj 

o,) 

Papaverine (papaverina). — Crystallizable, alkaline. (C ai H 31 N 1 4 .) 
Rhoeadine. — Crystallizable, not distinctly alkaline ; can be sub- 
limed. (0,^,^0..) 

Meconidine. — Amorphous, alkaline ; melts at 58° ; not stable ; the 
salts also easily altered. (C 2 H 23 N 1 4 .) 

Cryptopine (cryptopina). — Crystallizable, alkaline ; salts tend to 
gelatinize ; hydrochlorate crystallizes in tufts. (C^H^NjO^) 
JLaudanosine. — Crystallizable, alkaline. (C 31 H 27 N x 4 .) 
Narcotine (narcotina). — Crystallizable, not alkaline ; salts not sta- 
ble. (CmHmNxOt.) 

Lanthopine. — Microscopic crystals, not alkaline. (C 3 ,H 35 N 1 4 .) 

Narceine (narceina). — Crystallizable as a hydrate ; readily soluble 
in boiling water or in alkalies. (CaaHaoNiOg.) 

The only important derivative in the therapeutic sense is apomor- 
phine, obtained from morphine by the action of hydrochloric acid. 
This possesses active emetic property, and will be grouped with 
emetics. 

Besides the foregoing alkaloidal and basic substances, opium con- 
tains a peculiar acid (meconic acid), and, according to T. and H. Smith, 
a peculiar form of lactic acid (thebolactic). 

The proportion of morphine in Turkey opium should not be less 
than ten per cent, and in good specimens may reach fifteen per cent. 
Pseudo-morphine occurs in the minute quantity of 0*02 per cent. The 
proportion of codeine varies from one fifth to two fifths per cent. The- 
baine and papaverine exist in Turkey opium in about the proportion 
of one per cent. Narcotine is found in considerable quantity in differ- 
ent varieties of opium, and ranges in amount from one and five tenths 
to ten per cent. Narceine varies from 0*1 to 0*71. The quantity of 
cryptopine and rhoeadine is extremely small. 

The morphine of opium exists in the drug in the form of the tri- 
basic meconate. The proportion of meconic acid is about three to four 
per cent of the crude opium. 



518 CEREBRAL SEDATIVES. 

The value of opium depends on the quantity of morphine which it 
contains. 

Morphina. — Morphine. In colorless crystals, which are inflammable 
and wholly dissipated by red heat. It is scarcely soluble in cold water, 
slightly so in boiling water, and freely soluble in boiling alcohol. 
Nitric acid first reddens it, and then renders it yellow. With a solu- 
tion of sesquichloride of iron, it assumes a deep-blue color. Its so- 
lution restores the color of litmus, previously reddened by an acid. 
(IT. S. P.) 

Morphince Acetas. — Acetate of morphine. A white, yellowish- 
white, crystalline or amorphous powder, slowly losing acetic acid when 
kept for some time and exposed to the air, having a faintly acetous 
odor, a bitter taste, and a neutral or faintly alkaline reaction, When 
freshly prepared, the salt is soluble in twelve parts of water and in 
sixty-eight parts of alcohol ; if it has been kept for some time, it is 
incompletely soluble in water, unless a little acetic acid is added. Dose, 

g r - i~ g r - ss - 

Morphince Hydrochloras. — Hydrochlorate of morphine. In snow- 
white, feathery crystals, wholly soluble in water and in alcohol. Dose, 
g r - -1— gr. ss. 

Morphince Sutyhas. — Sulphate of morphine. In snow-white, feath- 
ery crystals, which are wholly soluble in water. Dose, gr. £ — gr. ss. 

Pulvis Morphince Compositus. — Compound powder of morphine 
(Tully's powder). (Morphine sulphate, one part ; camphor, twenty 
parts ; glycyrrhiza, twenty parts ; precipitated carbonate of calcium, 
twenty parts ; and sufficient alcohol to make a mixture.) Dose, gr. j 
— gr. x. 

Trochisci 3Iorphince et Ipecacuanhce. — Troches of morphine and 
ipecacuanha. (Morphine, ipecac, sugar, oil of gaultheria, mucilage.) 

Codeina. — Codeine. White, or yellowish-white, more or less trans- 
lucent, rhombic prisms, somewhat efflorescent in warm air, odorless, 
having a slightly bitter taste and an alkaline reaction. Soluble in 
eighty parts of water at 60° Fahr. and in seventeen parts of boiling 
water ; very soluble in alcohol and in chloroform ; also, soluble in six 
parts of ether. Dose, gr. ss — gr. ij. 

Various salts of codeine are now prepared, but the sulphate is the 
most important and desirable. 

The other alkaloids of opium are not official. 

JVarcotince Hydrochloras. — Hydrochlorate of narcotine (not offi- 
cial). Dose, gr. ij — gr. x, as an antiperiodic. 

Antagonists and Incompatibles. — As regards chemical antago- 
nism, the alkaline carbonates, lime-water, and the salts of iron, lead, 
copper, zinc, mercury, and Fowler's solution, are incompatible with 
the preparations of opium. Notwithstanding this chemical incom- 



OPIUM. 519 

patibility, the metallic salts are frequently given in conjunction with 
opium, and the systemic effects of both are produced. Astringent 
vegetables (tannin) are also incompatible ; they limit physiological 
activity by forming tannate of morphine, which is not readily soluble. 

In cases of opium-poisoning, if any portion of the drug remain un- 
absorbed in the stomach, the most prompt and efficient emetic should 
be used. Apomorphine should be injected subcutaneously, if the patient 
is unable to swallow ; if conscious, the sulphate of copper may be ad- 
ministered by the stomach. In a case of opium narcosis which re- 
sisted ordinary emetics, violent emesis was induced by a solution of 
bicarbonate of sodium, followed by a solution of tartaric acid. In the 
absence of other and more active emetics, powdered mustard may be 
administered — a tablespoonful to a teacupful of warm water. When 
the opium swallowed is in solution, the stomach-pump should be used 
if the narcosis is profound. Cold affusion, artificial respiration, when 
the breathing flags, and faradization of the chest-muscles, are measures 
of great practical utility. The author has personally witnessed in 
several cases the excellent effects of faradization, first, in causing such 
irritation of the surface as to produce reflex excitation of the respi- 
ratory center ; and, second, inducing contractions of the respiratory 
muscles. As a peripheral irritant, faradization is more humane and 
seemly, and also more efficient, than flagellation. 

The action of opium is antagonized, at least in a part of the sphere 
of its influence, by belladonna. These agents are opposed as regards 
their influence on the intra-cranial circulation, on the pupil, on the re- 
spiratory organs, and on the heart. Opium in lethal doses dilates the 
arterioles and veins ; belladonna contracts them, and, by energizing the 
cardiac movements, substitutes an active for a passive congestion. It 
can not be too strongly insisted on in this connection that belladonna 
in too great quantity r , or too long in action, exhausts the irritability 
of the unstriped muscular fiber, and thus induces the very state tohich 
its administration loas intended to relieve. The state of the pupil, the 
action of the heart, and the condition of the reflex movements, are the 
guides to the administration of belladonna in cases of opium narcosis. 
The smallest quantity of belladonna which will dilate the pupil, raise 
the tension of the arterial system, deepen the respiration, and re-estab- 
lish the reflex excitability, should be used. The author has a strong 
conviction, arising from some painful personal experience, that it is a 
fatal error to attempt to restore a patient in opium narcosis to com- 
plete conscious?iess by repeated doses of belladonna. The action of 
these agents combined is to produce profound sopor, and this is not a 
condition of danger so long as the pulse, respiration, and reflex move- 
ments are in good condition. To substitute belladonna narcosis for 
opium narcosis is only increasing the hazard under which the patient is 
already struggling. Impatient to afford relief, and assuming that the 



520 CEREBRAL SEDATIVES. 

tendency to sleep must be obviated, the physician too frequently, as the 
history of many cases plainly shows, repeats the doses of belladonna 
until its action greatly preponderates, and the irritability of the cardiac 
ganglia is completely exhausted. The author, therefore, feels himself 
warranted in repeating that the utility of belladonna consists in its 
power to maintain the action of the heart, and the respiration, until 
elimination has taken place, and that even coma is of little importance 
provided the respiration, circulation, and reflex movements are prop- 
erly maintained. 

The hypodermatic injection of atropine is the most efficient and 
satisfactory method of employing this physiological antagonist. Not 
more than -j-J-g- of a grain of the sulphate should be administered at a 
dose, and this may be repeated every fifteen minutes (up to three 
doses) until dilatation of the pupil, increased power of the cardiac move- 
ments, deeper respiration, warmth and dryness of the skin, and flush- 
ing of the face, are produced. No more can be accomplished by the 
largest doses, and the results of the antagonism must be awaited. 
Belladonna continues longer in action than opium. In a succeeding 
chapter, devoted to the consideration of the combined administration 
of opium and belladonna, or morphine and atropine, the nature and 
degree of the antagonism will be more fully elaborated. 

Coffee, with its active principle {caffeine), is also an antagonist to 
opium. Good results have undoubtedly been obtained by the free use 
of black coffee, in milder cases of opium narcosis. The unpleasant 
confusion of mind, and vertigo, which in so many subjects are experi- 
enced after the subsidence of the effects of a medicinal dose, may some- 
times be removed by a cup of strong coffee. These cerebral effects 
may be prevented, or relieved when they occur, by a full dose of bro- 
mide of potassium. This discovery, if we may dignify so small a mat- 
ter by so imposing a title, was briefly announced by the author in the 
first edition of his work on "Hypodermatic Medication," and was 
afterward more fully set forth in a special memoir by Da Costa, of 
Philadelphia. 

Gubler has shown that some of the cerebral effects of opium are 
antagonized by quinine. Tartar emetic and digitalis also oppose to 
some extent the action of this remedy on the intra-cranial circulation. 

Synekgists. — The cerebral and hypnotic effects of opium are pro- 
moted by alcohol and its derivatives (notably chloral), and, within 
certain limits, by the mydriatics. The sudorific action of opium is in- 
creased by ipecacuanha. 

Physiological Actions. — As opium is a very complex substance, 
made up of numerous principles which differ remarkably among them- 
selves, it will conduce to a better understanding of its actions to con- 
sider, first, opium as a whole, and then follow with some details re- 
garding its individual constituents. 



OPIUM. 521 

The physiological effects of opium are best studied as respects — 1. 
Small medicinal doses ; 2. Full medicinal doses ; 3. Lethal doses. 

1. The preparations of opium have a disagreeable, bitter, and rather 
nauseous taste. Dryness of the mouth and fauces, huskiness of voice, 
and diminution in the sense of taste, occur in a short time after admin- 
istration of the drug has begun, and continue during the whole period 
of its influence. To the dryness succeeds a viscid secretion, which 
contains excrementitious matter having a foul odor. When opium 
does not produce nausea, the appetite may not be impaired, may be 
even increased ; but the rule is that the desire for food is lessened by 
opium. The secretion of mucus, and of the special glandular appara- 
tus of the gastro-intestinal mucous membrane, is lessened by opium, 
and hence the digestion and the peristaltic movements are less active. 
The excretions being thus locked up, dullness and hebetude are expe- 
rienced, the skin looks muddy, the tongue is coated, and the breath is 
offensive. When the influence of the opium ceases, it not unfrequent- 
ly happens that the constipation is succeeded by relaxation of the in- 
testines, and rather profuse and fetid evacuations, and increased urin- 
ary discharges, take place. 

The action of the heart becomes stronger, and the arterial tension 
rises. When opium agrees, the sense of fatigue vanishes, and muscu- 
lar movements become more rapid and easy. The face flushes a little, 
the pupil contracts slightly, the conjunctivae may be somewhat in- 
jected, and the expression of the eye more brilliant. At this stage the 
ideas flow more rapidly, but are less sustained and orderly. The ap- 
preciation of time, the sequence of events, and the sense of moral fit- 
ness, are diminished. The cerebral excitement is, after a period which 
varies in different individuals, succeeded by calm, by drowsiness, and 
sleep when it occurs is usually disturbed by visions and dreams, often 
of a frightful character. In most subjects, after the sopor has passed 
off, headache, vertigo, confusion of mind, nausea, constipation, and 
muscular hebetude, are experienced. 

2. When full medicinal doses are administered, the symptoms 
above described occur in a more intense degree. The stage of cardiac 
stimulation and of cerebral excitement is of much shorter duration ; 
and the stage of intoxication and sopor not only comes on more quick- 
ly, but is much more pronounced. At first the pulse is increased in 
frequency and the respiratory movements are more rapid ; but the car- 
diac pulsations soon diminish in number and force, and the respira- 
tions become sighing in character and more shallow. There is also 
present decided dryness of the mouth, fauces, and larynx, and swallow- 
ing becomes somewhat difficult and the voice grows husky. Nausea 
and vomiting, or at least weight and oppression of the epigastrium, 
ensue. Confusion of ideas, vertigo, somnolence, are succeeded by 
deep sleep, contracted pupils, slow and relaxed pulse, slow and snoring 



522 CEREBRAL SEDATIVES. 

respirations, a perspiring skin, and, in many persons, an intense gen- 
eral pruritus, which, however, is more harassing at the nasal orifices. 

Persons not habituated to the use of opium usually experience, after 
a full medicinal dose has expended its force, very distressing sequela?, 
referable to the cerebro-spinal system. The most important of these 
after-effects are headache, confusion of mind, vertigo — which is espe- 
cially severe on assuming the erect posture — nausea, retching and vom- 
iting, complete anorexia, and constipation. A mild but defined hepa- 
togenic jaundice not unfrequently occurs, and the urine is tinged with 
the coloring-matter of the bile. 

3. A lethal dose of opium causes but a transient excitement ; the 
stage of narcosis quickly supervenes, and the functions of animal life 
are often rather abruptly suspended. The patient soon lapses into a 
condition of insensibility, with a slow and feeble, or, it may be, rapid 
and feeble, action of the heart ; slow respiration, shallow and quiet or 
stertorous ; face at first flushed, but soon becoming shrunken, pallid, 
and cyanosed ; skin wet ; pupils minutely contracted and insensible to 
stimulation ; unconsciousness profound, with muscular relaxation and 
abolition of reflex movements. This state of opium narcosis is with dif- 
ficulty distinguished from alcohol narcosis, from cerebral haemorrhage 
— especially in the pons — and from uraemic coma. An attentive con- 
sideration must be given to all available facts in the history of the 
case, to the surroundings of the patient, and to the odor of the breath 
or other excretions, for the symptoms of one of the states above men- 
tioned may be represented in another, even to the inequality of the 
pupils, since a case of opium narcosis has been reported in which such 
inequality existed. 

There are no characteristic structural alterations produced by opi- 
um. The brain presents the appearance known as the "wet brain" 
by pathologists ; the subarachnoid spaces and the ventricles contain an 
abnormal quantity of serum ; the intra-cranial veins are engorged, and 
the puneta vasculosa are somewhat more numerous. The right cavi- 
ties of the heart and the large venous trunks are usually distended 
with soft coagula. These appearances are largely due to the mode 
of dying. In consequence of the diminishing frequency of the respir- 
atory movements, the blood is imperfectly decarbonized, and the capil- 
lary circulation of the lungs is impeded. The action of the heart 
being weak and the resistance a fronte increased, it is obvious that 
venous stasis must take place. 

It is necessary now to consider somewhat more minutely the na- 
ture and degree of the action of opium on the different organs and 
systems of the body. It will save space and avoid repetitions to 
study these actions in connection with the several principles contained 
in opium. 

The Physiological Action of the Alkaloids of Opium. — 1. 



OPIUM. 523 

Morphine. — The peculiar powers of opium are represented chiefly in 
the morphine which it contains. In opium of good quality the pro- 
portion of morphine is from ten to fifteen per cent. The actions of 
the other principles contained in opium differ widely ; and as they all 
possess some activity, the sum of their effects must so far influence the 
result that the powers of opium and morphine must vary somewhat in 
kind as well as in degree. One sixth of a grain of morphine is about 
equivalent in activity to one grain of average opium. 

In general terms, it may be stated that morphine differs from opi- 
um in the following respects : 

Morphine is less stimulating, less convulsant, and more decidedly 
hypnotic and anodyne than opium. 

Morphine constipates less and affects the contractility of the blad- 
der more than opium. 

Morphine has less diaphoretic action and produces much more pru- 
ritus than opium. 

The physiological action of morphine is best studied as adminis- 
tered subcutaneously. In a short period — from a few seconds to a few 
minutes — after the insertion of an ordinary dose — one sixth to one 
fourth of a grain — under the skin, the symptoms of morphine narco- 
sis begin. A sense of heat and flushing of the face — after, in most 
subjects, a very transient pallor — fullness of the head, giddiness, tin- 
nitus aurium, and frequently nausea, are experienced. Deep-seated 
epigastric pain is often felt, and loud borborygmi occur. The verti- 
go may be so considerable as to render walking uncertain and stag- 
gering, or to render the upright position impossible. Injection of 
the conjunctivae and contraction of the pupils occur at the same time 
the cerebral effects are experienced. The lips have a bluish appearance, 
the mouth and tongue become dry, swallowing is painful, and the 
voice has a husky tone. When these physiological effects are produced, 
pain and spasm are relieved, and an indescribable feeling of content 
takes possession of the mind. A condition of somnolence in many 
persons, in others of extreme wakefulness, with intense mental activity, 
is experienced. When sleep occurs, it is usually deep but not calm, 
the respirations are slow, noisy, and labored. Not unfrequently the 
sleep is disturbed by dreams and visions, or the individual passes into 
a somnambulistic state> from which he is aroused with difficulty. The 
action of the heart is diminished in frequency, but a decided rise 
takes place in the arterial tension. On ophthalmoscopic examination, 
a marked increase in the vascularity of the retina, and blurring of the 
papillae, can be discerned. 

Soon after a hypodermatic injection has been practiced, itching of 
the nose, and often of the whole cutaneous surface, is experienced. 
The skin is at first dry, but, after a time, diaphoresis begins and is 
sometimes profuse. The relaxation of the skin is coincident with a 



524 CEREBRAL SEDATIVES. 

fall in the arterial tension. The secretions of the mucous surfaces are 
at first arrested, as well as those of the skin. If the morphine be ad- 
ministered after a full meal, digestion is suspended for a time. The 
intestinal movements are also arrested for a short period, and consti- 
pation is therefore produced ; but, very frequently indeed, no change 
takes place in the time in which the alvine discharges occur, or in their 
number. Partly in consequence of the increased action of the skin, 
the quantity of urine discharged is lessened, and, at the same time, 
difficulty is encountered in its emission. When the desire is felt, an 
interval of less or greater duration elapses before the flow begins, and, 
as the contractile power of the bladder and of the ejaculatory mus- 
cles is diminished, the discharge is feeble and slow, and the last drops 
linger in the urethra. 

With the decline of morphine narcosis a majority of subjects, prob- 
ably, experience headache, confusion of mind, anorexia, and nausea. 

When a lethal dose of morphine has been administered by any 
mode, profound narcotism quickly ensues ; the pulse becomes slow and 
feeble, or rapid and feeble ; the respirations also become very slow 
and shallow ; the skin cold and sweating ; the face pale, cyanosed, and 
ghastly ; the conjunctivae deeply injected ; the pupils minutely con- 
tracted, and reflex movements entirely abolished. Respiration ceases 
before the action of the heart, as a rule, but in some instances very 
sudden death ensues from paralysis of the heart. 

Half a grain is the smallest dose of morphine which has proved 
fatal to an adult. Five cases, according to Taylor, have been recorded 
in which one grain of the muriate caused death. 

A consideration of the symptoms produced in man by morphine, 
and the results of experiments on animals, prove that it chiefly affects 
the cerebro-spinal functions. In the lower animals, the spinal more ; 
in man, the cerebral more than the spinal functions. Morphine first 
raises and afterward lessens the action of the heart and arteries ; first 
stimulates the pneumogastric end-organs and cardiac motor ganglia, 
and afterward paralyzes both. It causes death chiefly through paral- 
ysis of the muscles of respiration. 

2. Codeine. — According to the author's observations, the codeine of 
commerce corresponds closely in action to morphine, but is much fee- 
bler. Four grains of codeine are about equivalent to one grain of 
morphine. It has anodyne and hypnotic qualities. Codeine produces 
sleep freer from disturbance, and the after-effects are less disagreeable, 
than those of morphine. The special direction to the pneumogastric 
nerve ascribed to it by some observers, seems to the author to exist in 
nature. 

3. JVarcotine. — This alkaloid is singularly inappropriately named. 
It has but feeble narcotic power. In children considerable doses pro- 
duce a calmative effect and drowsiness, but these results are not ob- 



OPIUM. 525 

served in adults. Experiments on animals have shown that narcotine 
is a convulsant. While pigeons are poisoned only by two or three 
grains of morphine, administered subcutaneously, the same quantity 
of narcotine causes fatal convulsions. The reverse is true in man. 
Narcotine is allied in action to berberine, and alkaloids of that group, 
so far as the effects on man are concerned ; and to thebaine, picro- 
toxin, strychnine, and brucine, so far as the effects on animals are 
concerned. 

4. JVareeine. — The most contradictory observations have been pub- 
lished on the action of this principle. By Bernard, Behier, and Eu- 
lenburg, it is held to possess remarkable hypnotic power, and to be 
free from stimulating and convulsant action ; by Fronmtiller, Harley, 
Da Costa, Mitchell, and others, it is considered feeble, if not inert. 
The physiological actions of narceine, therefore, remain sub judice. 
Until further researches are made with chemically pure narceine, and 
by competent observers, it will be safer to give no opinion on the sub- 
ject of its actions and uses. 

The other alkaloids of opium are curiosities of chemical and physi- 
ological research, and may be dismissed in a few words. 

Cryptopine is in a much greater degree than narceine an hypnotic 
and anodyne. 

Thebaine has a strong convulsant action in animals. 

Various circumstances modify the action of opium. These are 
chiefly age, sex, idiosyncrasy, habitual use, and certain states of the 
system, as the presence of pain, uramiia, etc. 

The extremes of life are relatively more susceptible to the action 
of opium, and especially is the susceptibility to its action great in 
early life. Fatal opium narcosis has ensued in a nursing infant whose 
mother had taken a medicinal dose. A single drop of laudanum has 
produced lethal effects in a child under six months of age. Women 
are more easily affected by opium than men, and they are more apt to 
be thrown into a condition of hysterical excitement than put to sleep. 
Nausea, vomiting, headache, and depression, much more frequently 
occur in women than in men. As a rule, therefore — but to this rule 
there are, of course, numerous exceptions — women are less favorable 
subjects for the administration of opium than men. 

More than age or sex is the action of opium influenced by idiosyn- 
crasy. There are persons so easily affected by it that the minutest 
quantity will cause uncontrollable vomiting, faintness, vertigo, and 
alarming prostration. It is never safe to administer morphine hypo- 
dermatically to such subjects, unless in an extremely small dose. 

The habitual use of opium diminishes in a remarkable degree the 
susceptibility to its action. Numerous instances are on record in which 
a pint or more of laudanum has been taken daily, or several hundred 



526 CEREBRAL SEDATIVES. 

grains of opium, or a scruple of morphine. The author has met with 
a patient who took a scruple of morphine a day subcutaneously. When 
opium is given by the stomach, for the relief of a chronic painful 
disease, to maintain a constant effect increasing doses are necessary. 
The power of the stomach to absorb opium is doubtless impaired by 
frequent repetition of the dose, and in consequence of the local action 
of the drug on the nerves of the stomach. Besides this, the suscep- 
tibility of the cerebro-spinal system steadily declines. The proof of 
these statements is afforded by the action of morphine when used sub- 
cutaneously for long periods. A gradual increase of the dose becomes 
necessary in order to produce a given physiological effect ; but the in- 
crease is much slower than when it is administered by the stomach. 

Great pain lessens the influence of opium upon the centers of con- 
scious impressions. The quantity in grains is of much less importance 
than the quantity as measured by the physiological reactions. Uraemia, 
or the retention in the blood of urinary excrementitious matters, is 
supposed to increase the narcotic influence of opium ; but some facts, 
to be hereafter presented, render it probable that the state of uraemia 
and the influence of opium on the brain are antagonistic. 

Therapy. — Stomach-pain, whether simply neuralgic (gastralgia), 
or excited by the presence of food {irritative dyspepsia), or due to 
ulcer or cancer, is relieved by opium. The preparations of morphine 
are better than the crude drug, as a rule, in these cases. The endermic 
application is an excellent mode of procuring relief. The subcutane- 
ous injection, practiced in the epigastric region, is still more effective. 
Morphine is frequently combined with bismuth, or zinc, or silver salts, 
in painful stomach diseases. 3 Bismuthi subcarb., vel subnitrat., 
3 iij ; morphinae sulph., gr. j — grs. ij ; pulv. aromat., 3 j. M. Ft. pulv. 
no. xij. Sig. : A powder in milk before each meal. The following 
formula is also useful, notwithstanding its unchemical relations : 3 
Zinci oxidi, 3 ss ; morphinae sulph., gr. j — grs. ij. M. Ft. pil. no. x. 
Sig. : One pill, three times a day, before each meal. A half-grain of 
the oxide of silver may be substituted for the oxide of zinc in the 
above formula. 

Inflammatory pain, due to corrosive poisons, to peritonitis, etc., 
requires opium. When the stomach is irritable, and the symptoms 
urgent, the best mode of using the remedy is the hypodermatic injec- 
tion of morphine. Many kinds of nausea and vomiting, stomachal or 
reflex in origin, are arrested by opium preparations. In vomiting of 
cerebral origin, or produced by uraemia, or caused by cirrhosis, the 
use of opium is contraindicated. When vomiting is caused by irritant 
matters, opium is prescribed after the stomach is emptied. The vomit- 
ing which accompanies the passage of biliary or renal calculi, dys- 
menorrhoea, etc., is best relieved by opium. Very severe cases of 
seasickness, and of the vomiting of pregnancy, may be sometimes 



OPIUM. 527 

arrested when all other means fail, by the subcutaneous use of a mi- 
nute quantity of morphine (one twentieth to one twelfth of a grain) . 

Nothing is more common than the prescription of opium in diar- 
rhoeal diseases, but it is often used without a just appreciation of the 
conditions requiring it. In acute diarrhoea, caused by irritating ali- 
ments, such astringent laxatives as rhubarb, or mild salines, should 
precede the use of opium. When the evacuations are watery, the 
best results are obtained by a combination of opium with mineral 
acids, or acetate of lead. In acute dysentery opium is a very im- 
portant remedy, but it is often injudiciously employed. If there be 
fever, much tenesmus, and the stools consist of mucus and blood, the 
exhibition of opium should be postponed until salines have emptied 
the intestinal canal of its contents, and have depleted the distended 
vessels. An excellent method of administration, especially when the 
dysenteric inflammation occupies the rectum, is an enema of starch or 
milk, or a suppository, containing opium in some soluble form. In 
chronic dysentery opium is indispensable. It is usually combined 
with arsenic, or with the salts of silver, copper, or zinc. In the 
chronic dysentery of malarial origin, the best results are obtained by 
a combination of arsenic and opium, according to a formula already 
given ; in that form which succeeds to the acute disease, opium and 
sulphate of copper, or zinc, or nitrate of silver, or vegetable astrin- 
gents. 

Nothing can be more satisfactory than the treatment of cholera- 
morbus by the hypodermatic injection of morphine. It is always 
desirable to secure the expulsion of irritating matters before resorting 
to opiates. For an ordinary case of cholera-morbus from one twelfth 
to one sixth of a grain of morphine suffices. In true cholera the 
utility of opium is most evident in the preliminary diarrhoea, but is 
entirely without avail in the stage of collapse. Mischief not unfre- 
quently results from its use, for patients emerging from the condition 
of collapse are either directly narcotized by the opium which had lain 
unabsorbed in the stomach, or the cerebral symptoms of the secondary 
fever are greatly intensified by it. In cholera infantum opium must 
be used with caution, if not avoided. The subjects of this malady 
are easily narcotized, and the nervous system — an unknown morbid 
state of which bears some close relation to the gastro-intestinal dis- 
order — is rendered so irritable by opium that the symptoms are ag- 
gravated by it. 

The following formula embodies a truth of great practical impor- 
tance : As a rule, opium does harm in all gastro-intestinal maladies 
in which there is a deficiency in the proper secretion, or a suspension 
of the functions, of the liver and kidneys. 

Opium gives a degree and kind of relief in hepatic, renal, and 
saturnine colic, which no other remedy or combination of remedies 



528 CEREBRAL SEDATIVES. 

affords. The most prompt and effective form in which the remedy 
can be administered is the hypodermatic injection of morphine. This 
relieves the pain, and relaxes the spasm of the affected tube, and at 
the same time checks the depressing vomiting which attends these 
cases. The quantity of morphine required will vary from one fourth 
to one half a grain. As the effect is immediate, the most prudent 
practice consists in the administration of a small quantity (one sixth 
to one eighth of a grain) for the first dose, in order to test the physi- 
ological capabilities of the patient, and following this in fifteen min- 
utes with a dose of similar size if the first is well borne and the pain 
persist. 

Opium, in small doses, is a valuable tonic to a weak and dilated 
heart. When administered simultaneously with digitalis, it obviates 
one of the dangers which may be caused by that agent. In the so- 
called passive haemorrhages , in which not only is the blood altered in 
quality but the tension is low, small doses of opium sustain the powers 
of life, and by increasing the arterial tension lessen the transudation 
through the vessel-walls. Under these circumstances, the dose of 
opium should not as a rule exceed five minims of the tinctures, and it 
should generally be given in combination with ergot, digitalis, tannic 
and gallic acids, acetate of lead, etc. 

The important observation was made by Bernard, and afterward 
illustrated and confirmed by Kussbaum, that the hypodermatic injec- 
tion of morphine, administered before the inhalation begins, prolongs 
the stage of chloroform narcosis with a less quantity of the anaesthetic, 
diminishes the danger of cardiac paralysis, and prevents the after-nau- 
sea and depression. 

Opium is the most important agent which we possess in the treat- 
ment of various inflammations. Its efficacy depends upon several fac- 
tors : it relieves pain, quiets restlessness, and thus removes from the 
inflammatory process one of its most important elements, viz., an irri- 
table and paretic state of the nerves of the affected part. Besides 
these effects, opium raises the tonicity of the vessels, helps to maintain 
the continuity of the blood-current, and hinders the migration of the 
white corpuscles of the blood. It is especially in inflammations of the 
serous membranes that its highest utility is manifest, e. g., pleuritis, 
peritonitis, arachnitis. Good reasons exist for believing that the hy- 
podermatic injection of morphine will sometimes cut short (jugulate) 
these maladies, if administered just at their onset. If the period for 
obtaining such a fortunate result has passed, the course and duration 
of these diseases can be greatly modified by the judicious use of opium. 
The quantity of opium required will be determined by the effect ; the 
pain should be relieved, the pupils somewhat contracted. A full dose 
should be administered at the beginning of treatment (two to three 
grains of opium — a half grain of morphine), and a given physiological 



OPIUM. 529 

effect be maintained by the regular use of smaller doses. Pain is 
probably the surest guide, for the existence of pain indicates that de- 
cided opium narcosis has not been attained. 

In peritonitis, whether puerperal, traumatic, or the extension of 
intestinal inflammation, no fact of therapeutics is better established 
than the curative power of opium. Besides its immediate influence 
over the inflammatory process, its indirect action, in maintaining the 
necessary quietude of the intestines, is of the greatest service. In 
arachnitis, pachymeningitis, basilar meningitis, there are clinical facts 
which tend to show that small doses of some opiate preparation really 
accomplish more than any other remedies. The author is convinced 
that we possess no means of treatment of cerebrospinal meningitis so 
effective as the opiate treatment. The same rule as to the quantity 
required, as that given for peritonitis, should be observed : that quan- 
tity of opium should be administered which will relieve the pains and 
rigidity. The best results are obtained by the hypodermatic injection 
of morphine. When effusion takes place, and stupor and coma ensue, 
the utility of opium is ended. 

In parenchymatous inflammations, experience has shown, opium is 
much less useful. When pain is a prominent symptom, it can be em- 
ployed to relieve it ; in small, stimulant doses, it may be given to 
maintain the action of the heart. In pneumonia opium is a remedy of 
very doubtful utility. Its narcotic action certainly disposes to pul- 
monary congestion, although it may be cautiously used to allay pain and 
moderate cough. Although this was the general professional opinion, 
and is now largely held, there are those who entertain very different 
views regarding the utility of opium in pneumonia. Thus, Prof. A. L. 
Loomis, of New York, maintains that the disease may be aborted, or 
at least decidedly modified in severity, by the subcutaneous injection 
of morphine in the first stage (congestion) of this disease. 

In fevers — typhoid, typhus, and eruptive fevers — opium was for- 
merly much more frequently prescribed than at present. The cold 
baths, antipyretics, and more favorable hygienic influences, have less- 
ened the violence and diminished the mortality from fevers. The 
maniacal excitement and the low, muttering delirium are not so fre- 
quently observed now as formerly, and hence the use of opium in these 
affections has greatly declined. The discovery of chloral has also di- 
minished the use of opium as an hypnotic. Nevertheless, when there 
is much restlessness, wakefulness, subsultus, and delirium, opium may 
render important service. When the delirium is of the low, mutter- 
ing kind, a small quantity of moiphine (one eighth to one sixth of a 
grain) may suffice to procure quiet and refreshing sleep. When the 
delirium is violent, combination of tartar-emetic with opium, on the 
plan of Graves, may have a very happy effect. Or opium may be 
combined with belladonna, or chloral — the former when the condition 
34 



530 CEREBRAL SEDATIVES. 

is one of great depression, the latter when the delirium and wakeful- 
ness are excited in character. In measles and scarlet fever, when there 
is a condition of profound depression, the eruption being tardy in 
making its appearance, and is dusky in hue and ill-defined, beneficial 
results are experienced from the use of opium, especially when com- 
bined with camphor. 

A threatened paroxysm of intermittent fever may be aborted by 
the hypodermatic injection of morphine (one fourth of a grain). This 
practice has a high degree of importance in the pernicious intermit- 
tens, when time is not afforded for an effective use of quinine. The fe- 
brile heat of intermittent and remittent fevers may be diminished, and 
the sweating stage induced earlier, by the use of opium in moderate 
doses (ten minims of the deodorized tincture every two, three, or four 
hours). The addition of morphine to quinine enables the latter to be 
better borne by the stomach, counteracts some of its unpleasant effects 
on the brain, and increases its therapeutical power. When no contra- 
indication to the use of morphine exists, it is good practice to combine 
it with quinine in the treatment of intermittent and remittent fevers. 

Narcotine has decided antiperiodic power, and may be given as a 
substitute for quinine when reasons exist to prevent the use of the lat- 
ter. From five to ten grains of pure narcotine may be administered. 
As an antiperiodic it ranks after arsenic, salicine, and even apiol. 

As an hypnotic opium is very frequently used in affections of the 
nervous system. The stimulant properties of crude opium, or its offi- 
cial preparations, render it less serviceable than morphine in the 
group of cases generally requiring an hypnotic. There can be no 
doubt that remarkable curative results have followed the hypodermatic 
injection of morphine in acute mania. The following are the indica- 
tions for the use of morphine in mental disorders : prolonged wakeful- 
ness, maniacal excitement, persistent refusal of food, drink, or medi- 
cine, destructive and suicidal tendencies. As respects individual 
subjects, the state of the arterial tension furnishes a guide to the use 
of morphine. If the tension of the arterial system is low, a small dose 
is required. When the pulse is quick, and the arterial tension high, a 
large dose of morphine, by over-excitation, causes paresis of the sym- 
pathetic, and thus reduces action, an indication for the full influence 
of the agent. Large doses of morphine, when given subcutaneously, 
require the utmost circumspection in maniacal cases, especially in 
obese and aged subjects. Besides acute mania, excellent results have 
followed from the use of morphine in lypemania (Krafft-Ebing, Voi- 
sin), in chronic mania, and melancholia. Probably the best effects 
have been witnessed from opium in melancholia. In this mental dis- 
order, which is a condition of depression, the best form for the admin- 
istration of opium is the tincture, and the dose required is the stimu- 
lant and not the narcotic dose. The author is impelled to add the 



OPIUM. 531 

caution so well expressed in the following words by Maudsley : " It 
will be well to have in mind that neither opium by the mouth, nor 
morphine hypodermically injected, will always quench the fury of 
acute mania, and that successive injections of morphine, followed by 
brief snatches of fitful sleep, have been followed also by fatal collapse." 

It was formerly held that large and increasing doses of opium were 
necessary for the cure of delirium tremens, the theory being enter- 
tained that to procure sleep was to insure recovery. It is now known 
that to re-establish digestion and to support the powers of life by suit- 
able nutrients are in a large proportion of cases the only means needed 
to quiet delirium and to cause sleep. Opium, if used at all, must be 
given cautiously. Chloral has to a large extent taken its place as an 
hypnotic in this disease, but cases are not unfrequently met with 
in which morphine agrees better, and is more effective in inducing 
quiet. 

Some cases of sunstroke, coup de soleil, or "thermic fever," are 
rapidly cured by the hypodermatic injection of morphine. When the 
patient is able to swallow, good effects follow the conjoined admin- 
istration of tincture of opium and brandy. The cases benefited by 
this treatment are characterized by pallor of the face and weakness of 
the heart — heat exhaustion. 

Epilepsy and epileptiform seizures may be sometimes prevented by 
the timely administration of morphine hypodermatically. This treat- 
ment is best adapted to epilepsy, the attacks of which occur at night, 
to petit maly and to convulsive tic. It is improper in epileptoid seiz- 
ures due to tumor or other coarse organic lesion of the brain. In 
suitable cases, this treatment procures most decided amelioration in 
the condition of the patient, but may induce the opium habit. 

The remarkable fact has been demonstrated by Loomis, of New 
York, that we have in the hypodermatic injection of morphine the 
most important agent for the cure of urcemic convulsions, puerperal 
and non-puerperal. It is true this mode of treatment had been origi- 
nally practiced by Scanzoni, but Loomis has, more especially, drawn 
attention to its real power and utility. " The most uniform effect of 
morphine so administered is, first, to arrest muscular spasms by coun- 
teracting the effect of the uraemic poison on the nerve-centers ; second, 
to establish profuse diaphoresis ; third, to facilitate the action of ca- 
thartics and diuretics, especially the diuretic action of digitalis." 

In chorea Trousseau has carried the administration of morphine to 
an extraordinary extent. He restricts its use to severe cases, which 
appear to have a singular insusceptibility to the action of opium even 
in enormous doses. When the jactitations are incessant, preventing 
sleep, or persisting in spite of sleep, the utility of morphine is very 
great. It is most effective when combined with chloral. In these se- 
vere cases of chorea, the only limit to the quantity of morphine is the 



532 CEREBRAL SEDATIVES. 

effect produced. It is evident, from the experiences of Trousseau, 
that very large doses are required, and that curative effects are thus 
obtained to which small doses are entirely inadequate. The subcu- 
taneous method is more efficient than the stomach administration. 

In tetanus and hydrophobia the use of morphine has been chiefly 
palliative. M. Demarquay has, however, applied morphine, by deep 
injection into the tetanized muscles, with greater success than hereto- 
fore. He carries the needle deeply into the tetanized muscles, and, if 
possible, to the point of entrance of the nerves. He injects in this 
way the masseters, the sterno-cleido -mastoid, the neck and sacro-lum- 
bar muscles, etc. The relaxation of the muscles of mastication thus 
induced permitted the nourishment of the patients. Of three cases 
thus treated during the siege of Paris two recovered and one died, but 
the death was due to pyaemia and not to tetanus. 

The most important uses of opium and its various preparations are 
in the relief of pain. In surgical practice its administration is indis- 
pensable to prevent or mitigate shock, to quiet pain, and to check in- 
flammation. To particularize on these points would require an epit- 
ome of surgery for illustration. Before the administration of chloro- 
form, morphine should be injected hypodermatically, to diminish the 
dangers of the inhalation and to secure relief to the after-pain of the 
surgical operation. Nothing is more universal in surgical practice 
than the administration of an opiate after an operation of any magni- 
tude, for the objects above named. 

The most signal service is rendered by opium and its preparations 
in the various neuralgias. The most effective mode of administration 
is by subcutaneous injection, and the remedy should be inserted in the 
neighborhood of the affected nerve, notwithstanding that relief is af- 
forded by the injection at any point. In tic- douloureux, brachialgia, 
cardialgia, gastralgia, hepatalgia, nephralgia, sciatica, and pelvic neu- 
ralgias, immediate relief is afforded by this remedy, and the relief is 
not temporary and palliative merely, but curative in numerous instances. 
It appears to be especially curative in sciatica. It is a remarkable fact 
that morphine inserted under the skin, and especially in the neighbor- 
hood of affected nerves, exerts a curative power which it does not at all 
have when administered by the stomach. An efficient method of using 
morphine in the treatment of neuralgise, according to Brown-Sequard, 
consists in applying it in a finely-divided state to the derma, denuded 
by a blister. Laf argue proposed the method of inoculation, which con- 
sists in inserting morphine into the skin by means of a lancet-puncture. 
These clumsy and painful processes are by no means equal to the hypo- 
dermatic method. 

The enchanting sense of relief to suffering wrought by opiates, and 
especially by the subcutaneous use of morphine, leads to the morphine - 
habit. It is a singular fact that in these cases the pains which were 



OPIUM. 533 

cured by the remedy return when it is withdrawn, and other painful 
sensations appear of an even more distressing kind. In practicing the 
hypodermatic method for a long period in severe cases of neuralgia, 
the utmost care should be used to avoid the morphine-habit. 

In the neuroses of the respiratory organs, great relief is often af- 
forded by the use of opium in some of its forms. No remedial agent' 
will so quickly cut short a paroxysm of asthma as the hypodermatic 
use of morphine. The paroxysms of difficult breathing which occur in 
emphysema are also readily relieved in the same way. But there is 
great danger of establishing the opium-habit in these chronic cases. 
In an allied disease — hay-fever, hay-asthma, or autumnal catarrh — 
the hypodermatic use of morphine is quite as effective as in spasmodic 
asthma. An incipient catarrh may be aborted by a full dose of Do- 
ver's powder, taken at the very outset of the inflammation. Morphine 
and quinine combined are rather more effective than Dover's powder 
in these cases. Opium, or some of its preparations, enter into the com- 
position of expectorant mixtures to allay cough. 

The hypodermatic injection of morphine has been shown to possess 
a high degree of utility in cases of dilated heart with difficult breath- 
ing, and general oedema. The eighth to the sixth of a grain suffices for 
this purpose. The effect it has is to quiet and regulate the action of 
the heart, to allay the distress of breathing, and to permit rest and 
sleep in the recumbent position. An occasional dose only is necessary 
(two or three times a week). 

Opium is a very important addition to our resources in the treat- 
ment of diabetes. It must be given in considerable doses, as Pavy has 
shown. From six to twelve grains a day are necessary, in order to pro- 
duce a decided impression. It checks the bulimia — the inordinate ap- 
petite — allays thirst, diminishes the flow of urine and the excretion of 
sugar, and, probably, arrests or prevents the changes in the nervous 
system which accompany or are causative of this disease. Although 
many cases are decidedly ameliorated, it can not be said that any have 
been cured by opium. Codeine, an alkaloid of opium, seems to be 
more effective in this disease than the crude opium or any of its prepa- 
rations. It must be given in full doses. Besides checking the waste, 
it apparently exercises an influence over the central nerve-changes, and 
thus has a curative action as well as merely palliative. 

External Uses of Opium. — A solution of morphine in distilled 
water is an excellent astringent anodyne in conjunctivitis, and, com- 
bined with atropine, in iritis. ££ Morphinae sulph., grs. iv — grs. viij ; 
aquae destil., § j. M. Sig. : A few drops to be put into the eye as neces- 
sary, ty Morphinae sulphatis, grs. iv ; zinci sulphatis, grs. ij ; aquae 
destil., 1 j. M. Sig.: Lotion for iritis and other inflammatory affec- 
tions of the eye. The last formula, omitting the zinc, is an excellent 
application in earache, the external meatus being filled with it, and in 



534 CEREBRAL SEDATIVES. 

toothache, a few drops on cotton being placed in the hollow of the 
tooth. 

Local inflammatory swellings, painful in character, can be relieved 
somewhat by poultices containing laudanum. Frictions with laudanum 
are serviceable in lumbago, sciatica, myalgia, and similar superficial 
painful affections. An infusion of opium ( 3 j — Oj), applied hot, is an 
excellent application to inflamed joints, inflamed testicle, etc. 

On the Combined Uses of Opium and Belladonna, Morphine, 
and Atropine. — The conjoined use of these agents is so important a 
subject from the point of view of practical therapeutics, that the author 
purposes to consider it under this head. Although a physiological an- 
tagonism as respects a part of their action unquestionably exists, it does 
not extend throughout their whole range of influence in the organism. 
The balance of actions furthermore produces results which neither is 
capable of singly. Hence the importance of a more direct presentation 
of these points than has been heretofore given. 

Both act on the brain, atropine causing delirium, hallucinations, and 
disturbed sleep ; morphine producing stupor, somnolence, hebetude of 
mind. Both relieve pain, but this effect is much greater in the case of 
morphine. Both produce disorders of motility, staggering, difficulty 
of co-ordination of muscular movements, vertigo, confusion of mind, 
and headache. The reciprocal influence exerted upon each other, when 
they are administered together, modifies in a remarkable manner their 
physiological effects. 

Morphine corrects the illusions and phantasms produced by atro- 
pine. In small doses (e. g., one ninety-sixth of a grain) atropine in- 
creases the hypnotic power of morphine, with the result of causing a 
less disturbed and more nearly normal sleep than is produced by mor- 
phine alone. If, however, the quantity of atropine be in excess of 
what is necessary to establish the physiological balance in the cere- 
brum, it overrides the action of morphine and asserts its own peculiar 
power of inducing phantasms, illusions, and hallucinations. 

The pain-relieving power of morphine is rather increased than di- 
minished by atropine. The disorders of motility are enhanced by the 
mutual reactions of the two agents. The after-headache, vertigo, 
nausea, and depression of the heart's action caused by morphine, are 
to a large extent prevented by the conjoined administration of atro- 
pine. When a large quantity of opium, or morphine, is given by any 
of the modes of administration, its immediate depressing effects are 
counteracted by the simultaneous use of belladonna or atropine. 
Morphine produces contraction of the pupil, and a tetanic condition 
(according to Graefe) of the muscle of accommodation ; atropine 
causes dilatation of the pupil and contraction of the ciliary muscle. 
When used together these effects may be precisely balanced. It re- 
quires but a minute quantity of atropine to overcome the action of 



OPIUM. 535 

morphine on the pupil. When these effects on the pupil are balanced, 
it does not follow that the muscle of accommodation is in a normal 
condition, for visual defects remain. Morphine prevents the contrac- 
tion of the arterioles produced by atropine, and, as a necessary conse- 
quence, the subsequent relaxation of the muscular fiber. 

Morphine depresses the action of the lungs ; atropine is a powerful 
respiratory stimulant. Morphine produces pallor of the surface, and 
reduces the external temperature ; atropine causes redness and injec- 
tion of the skin, and elevation of the body-heat. In some experiments 
the author ascertained that while atropine alone raised the pulse to 
105 from 72, atropine and morphine combined depressed the pulse of 
the same subject to 60. 

Both morphine and atropine produce dryness of the mucous mem- 
brane of the mouth and fauces. Morphine suspends, and atropine in- 
creases, the peristaltic movements. The sickness and nausea caused 
by morphine are, to a considerable extent, lessened or prevented by 
atropine. 

Morphine lessens and atropine increases the functional activity of 
the kidneys ; on the skin their effects are opposed ; hence, when used 
in combination, the urinary secretion is rather increased than dimin- 
ished by them. Both produce dysuria. 

Theeapeutical Applications of Opium asd Belladoxxa. — 
Whenever opium is used to relieve pain, to procure sleep, to relax 
spasm — there being no inflammatory action present — belladonna 
should be combined with it, unless some contraindication should exist 
to the action of the latter. This formulated expression is more espe- 
cially applicable to the hypodermatic use of morphine. 

In the various psychical disorders, in which the general condition 
is sthenic, opium or morphine should be used alone. When power is 
deficient, the forces depressed, the temperature rather below than 
above the normal, belladonna or atropine should be combined with the 
opium or morphine. For the relief of insomnia the combined action 
of these agents is much more effective than either singly. The pro- 
portion in which the alkaloids should be used is about as follows : 
yJ-q — j-J-g- of a grain of atropine to -^ and £ of a grain of. morphine. 

In the various convulsive disorders in which opium or morphine 
may be used, especially hypodermatically, atropine should be combined 
with it. 

The neuralgice are best treated by morphine and atropine com- 
bined, for the following reasons : the combination is more effective, 
the after-unpleasant effects of either are prevented to a considerable 
extent. 

The neuroses of the respiratory organs, of the abdominal viscera, 
etc., are, as a rule, more successfully treated by morphine and atropine 
in combination, than by either separately. 



536 CEREBRAL SEDATIVES. 

In surgical diseases and operations of various kinds, the combina- 
tion of morphine and atropine has most important and varied applica- 
tions, among which may be enumerated : to render safer and to pro- 
long ether or chloroform narcosis ; to prevent or relieve shock; to 
save suffering ; to relax muscles / to facilitate operative procedures. 

The combined administration of morphine and atropine is of the 
greatest service in obstetric practice : to relieve the teasing pains of 
the first stage / to procure sleep in the course of an exhausting labor ; 
to quiet after-pains ; to facilitate the performance of various obstetric 
operations ; to arrest pmer per al convulsions. 

Authorities referred to : 

Albers, Dr. J. H. F. Virchovfs Archiv, Band xxvi, p. 229. 

Allbdtt, Dr. T. C. The Practitioner, vol. iii, p. 342. Ibid., vol. v, p. 327. 

Anstie, Dr. F. E. Stimulants and Narcotics, American edition. Article Alcoholismus, 
Reynolds 's System of Medicine. The Practitioner, vol. i, No. 1, etc. 

Asche, Dr. Schmidt's Jahrbucher, Band cxxv, pp. 331-33*7. 

Bartholow, Dr. Roberts. Manual of Hypodermatic Medication, fourth edition. 

Bernard, Claude. Bulletin General de Therapeutique, vol. lxxvii, p. 241, et seq. 

Ibid. Archives Generates de Medccine, 1864. 

Bois, Dr. A. De la Methode des Injections Sous-cutanees, Paris, 1864, p. 17. 

Courtenay, Dr. E. M. West Biding Lunatic Asylum Reports, vol. ii, p. 254. 

Da Costa, Dr. J. M. Pennsylvania Hospital Reports, 1868. 

Demarquay, Dr. Bulletin General de Therapeutique, October 15, 1871, p. 229, et seq. 

Erlenmeyer, Dr. A. Die subcutancn Injcctionen dcr Arzneimiltcl, dritte Auflage, 
Neuwied, 1866. 

Eulenburg, Dr. A. Die hypodermatischen Injectioncn dcr Arzncimittcl, zweite Auflage, 
Berlin, 1867, p. 96, et seq. 

Ibid. Lehrbuch der functionellen Nervenkrankheiten, Berlin, 1871, p. 166, etc. 

Fluckiger and Hanbury. Pharmacographia, p. 40, et seq. 

Fronmuller, Dr. Klinische Studien uber die schlafmachende Wirkung der narkotischen 
Arzneimittel, Erlangen, 1869. 

Harley, Dr. John. Tlie Old Vegetable Neurotics. 

Hunter, Charles. On the Speedy Relief of Pain and other Nervous Affections by 
means of the Hypodermic Method, Churchill, London, 1865. 

Husemann, Drs. Aug. und Theod. Die Pfanzenstoffe, p. Ill, et seq. 

Husemann, Dr. Theodor. Handbuch der gesammten Arzneimittellehre, Berlin, 1875, 
zweiter Band, p. 1055, et seq. 

Hutchison, Dr. James H. Pennsylvania Hospital Reports. 

Krafft-Ebing, Dr. R. von. Bulletin General de Therapeutique, January 30, 1870, 
p. 474. 

Lawson, Dr. Henry. Sciatica, Lumbago, and Brachialgia, London, 1872. 

Loomis, Dr. A. L. Lectures on Diseases of the Respiratory Organs, Heart, and Kid- 
neys, New York, 1875, p. 450. 

Maudsley, Dr. H. Tlie Physiology and Pathology of the Nervous System, and Rey- 
nolds^ System of Medicine. 

Medico-Chirurgical Transactions, vol. 1, p. 561, et seq. 

Mitchell, Dr. S. Weir. American Journal of Medical Sciences, 1869-70, also in con- 
junction with Morehouse and Keen. 

Ibid. Injuries of Nerves and their Consequences. 

Nothnagel, Dr. Hermann. Handbuch der Arzneimittellehre, p. 1, et seq. 



HOPS. 537 

Reissner, Dr. Bulletin General de Therapeutique, January 30, 1870, p. 89. 

Robertson, Dr. C. Lockhart. The Practitioner, May, 1869, p. 2*72. 

Rosenthal, M. Klinik der Nervenkrankheiten, Stuttgart, 1875. 

Stille, Dr. Alfred. Epidemic Meningitis, and Therapeutics and Materia Medica. 

Taylor, Dr. A. S. On Poisons, third edition, London, 1875, p. 5-17. 

Trousseau, A. Clinique Medicate, vol. ii, p. 196. 

Ward, Dr. J. Bywater. West Riding Lunatic Asylum Reports, vol. i, p. 152. 

Wolff, Dr. 0. J. B. Archiv fur Psychiatrie und Nervenkrankheiten, Band ii. 

Humulus. — Hops. The strobiles of Stimulus lupulus Linne (Nat. 
Ord. Urticariacece, CannaMnece). 

Impulina. — Lupuline. The glandular powder separated from the 
strobiles of S. lupus. (U. S. P. ) Lupuline, Fr. ; Sopfendrusen, Ger. 

Infusum Stimuli. — Infusion of hops ( § ss — Oj). Dose, a teacup- 
ful or more. (Not official.) 

Tinctura Sumuli. — Tincture of hops (twenty parts to one hun- 
dred). Dose, 1 ss — § ij. 

Oleoresina Lupulinoe. — Oleo-resin of lupuline. Dose, ttx, v — 3 ss 
or more. 

Extractum Lupullnce Fluidum. — Fluid extract of lupuline. Dose, 
3 ss— 3 ij. 

Composition. — Hops contain lupuline (described above), a tannic 
acid, an essential oil composed in part of valerol, trimethylamine, and 
a liquid volatile alkaloid, lupuline (?). 

Physiological Actions. — Hop is an aromatic stomachic tonic, 
and as such promotes the appetite and digestive power. It is slightly 
astringent also. The action of the heart is somewht increased, the 
cutaneous circulation excited, and diaphoresis produced. 

In a very slight degree, hop first causes cerebral excitement, fol- 
lowed by calm and a disposition to sleep. Experience has shown that 
it possesses some anaphrodisiac property, and lessens the functional 
activity of the testes and the apparatus of erection. 

Therapy. — As a stomachic tonic hop is quite as serviceable as 
many more rare and costly medicines. It is useful in atonic dyspepsia, 
simple flatulent colic, and mild diarrhoeas. 

The power of a hop pillow to quiet the mind and to induce sleep 
seems to be well established, but its influence is, doubtless, largely due 
to imagination and the association of ideas. The tincture of lupuline 
and the oleo-resin are useful remedies in mild cases of delirium tremens. 
They serve a double purpose — as a stomachic tonic and cerebral seda- 
tive. A combination of fluid extract or tincture of lupuline and tinc- 
ture of capsicum is probably the best substitute for alcoholic stimulants, 
when the habit of their use is to be discontinued. t> Ext. lupulinre fluid., 
tinct. capsici, aa § j. M. Sig. : One or two teaspoonfuls as necessary. 
The condition known as horrors, or the wakefulness and excitement 
which just precede the attack of delirium tremens, may often be quite 
removed by free use of this combination. 



538 CEREBRAL SEDATIVES. 

Nocturnal seminal losses may be reduced in frequency by the use 
of lupuline, of which the best preparation for this purpose is the oleo- 
resin. Chordee is said to be prevented by the use of lupuline, but the 
author has been quite disappointed in his attempts to relieve this state 
by this remedy. 

A hop poultice or bag is a domestic remedy for internal pains and 
inflammation, especially of the abdominal organs. A quantity of hops 
is sewed into a muslin bag, dipped in hot water, and then laid over 
the affected region. It forms a light fomentation, which owes its 
virtues rather to the heat and moisture than to the anodyne qualities 
of the hops. 

Lactucarium. — Lactucarium. The concrete milk- juice of Bactuca 
virosa Linne (Nat. Ord. Composite^). (U. S. P.) Dose, gr. v — 3 j. 

Extr actum Lactucarii Fluidum. — Fluid extract of lactucarium. 
Dose, 3 ss — | ss, or more. 

Composition. — Lactucarium contains several organic substances 
and eight to ten per cent of inorganic matter. It yields about fifty- 
eight per cent of lactucerine or lactucone, an inodorous, tasteless 
neutral substance, a crystallizable bitter principle, lactucine, and lac- 
tucic acid. 

Physiological Action, and Therapy. — The soporific quality of 
lettuce is known to all who eat this vegetable. Notwithstanding this 
universal experience, careful experiments have shown that lactucarium 
possesses a very feeble hypnotic quality, if it be not entirely inert. It 
is only used as a substitute for opium and its alkaloids when these 
disagree. The sirup of lactucarium is prescribed to relieve cough, 
but it is better employed as a vehicle for more powerful agents of the 
class of expectorants. 

Bromides. — Ammonii Bromidum. Bromide of ammonium. Bro- 
mure d'ammonium, Fr. ; Bromcmimonium, Ger. Colorless, transpar- 
ent, prismatic crystals, or a white, granular salt, becoming yellow on 
long exposure to air, odorless, having a pungent, saline taste, and a 
neutral reaction. Soluble in 1*5 part of water and in 150 parts of 
alcohol at 60° Fahr. ; in 0*7 part of boiling water. Dose, gr. x — 3 ss, 
or more, well diluted. 

Calcii Bromidum. — Bromide of calcium. A white, granular salt, 
very deliquescent, odorless, having a pungent, saline, and bitter taste, 
and a neutral reaction. Soluble in 0*7 part of water and in 1 part of 
alcohol. Dose, 3] — 3 ij. 

Camphor a Monobromata. — (For description, see article C amphora.) 
Ethyl Bromide. — (For description, see article JEther.) 
Lithii Bromidum. — Bromide of lithium. A white, granular salt, 
very deliquescent, odorless, having a very sharp, somewhat bitter 



BROMIDES. 539 

taste, and a neutral reaction. Very soluble in water and in alcohol. 
Dose, gr. v — 3ij. 

Potassii Bromidum. — Bromide of potassium. Bromure de potas- 
sium, Fr. ; Bromkalium, Ger. Colorless, translucent, cubical crystals, 
permanent in dry air, odorless, having a pungent, saline taste, and a 
neutral reaction. Soluble in 1-6 part of water and in 200 parts of 
alcohol at 60° Fahr. Dose, 3 j— 3 ij. 

Sodii Bromidum. — Bromide of sodium. Small, colorless, or white 
monoclinic crystals, or a crystalline powder, permanent in dry air, 
odorless, saline taste and neutral reaction. Soluble in 12 parts of 
water and 13 parts of alcohol. Dose, 3] — 3 ij. (IT. S. P.) 

Antagonists and Incompatibles. — Acids, acidulous and metallic 
salts are incompatible with bromides of ammonium and potassium, and 
nitrous ether with the former. The physiological actions of the bro- 
mides are antagonized by cold, digitalis, belladonna, ergot, and other 
agents which energize the vaso-motor nervous system. 

Synergists.— Opium, chloral, and remedies belonging to the same 
group, promote the action of the bromides on the brain ; and aconite, 
veratrum viride, gelsemium, etc., increase the depressing effect of the 
bromides on the circulatory system. 

Physiological Actions. — The taste of a bromide is bitter and 
saline. In a short time after it is swallowed, the characteristic taste 
returns to the mouth, owing to the outward diffusion of a portion of 
that administered. The tactile sense of the fauces, as also the muscu- 
lar movements in the act of swallowing, are diminished by long-con- 
tinued use of the bromides. 

Sixty grains of the bromide of potassium or sodium, and a less 
quantity of the ammonium salt, will in some persons produce slight 
nausea and diarrhoea ; in others, a sense of coolness in the epigastric 
region ; but in many, provided the salt is properly diluted, no effect 
on the stomach. Gastric catarrh is undoubtedly one of the evil results 
which may follow the protracted administration of the bromides in 
considerable doses. 

These are diffusible substances, and hence pass quickly into the 
blood. When large doses are administered, it is probable that no 
inconsiderable portion escapes absorption, for they can be detected in 
the intestinal mucus and in the faeces. 

Very obvious effects on the action of the heart, on the respiration, 
and on the animal temperature, are produced by the bromides if admin- 
istered in considerable quantity. These functions are depressed, but 
the depression is much less evident as to temperature ; hence, in order 
to determine this result, most careful observations are necessary. The 
author has ascertained that two drachms of bromide of potassium will 
lower the temperature in a healthy adult from one fifth to one half a 
degree ; the respirations from two to five, and the pulse from ten to 



540 CEREBRAL SEDATIVES. 

twenty beats per minute. These effects are more pronounced in ani- 
mals, as ascertained by the administration of lethal doses. In man 
the number of the cardiac pulsations is not only reduced, but their 
force is diminished, and the tension of the arterial system is lowered. 

A transient excitement, intoxication, giddiness, in some persons an 
anxious mental state, are produced by one or several large doses. As 
a rule, slight somnolence, and sounder and more refreshing sleep result, 
provided no disturbing element intervenes. The pupil is not affected 
in its size and sensibility to luminous impressions in an adult man by 
a dose of one hundred and twenty grains. When long continued, the 
hypnotic effect is much more pronounced, and a constant drowsiness 
is experienced. The sensibility to pain, but especially the sensibility 
to tactile impressions, is lowered by the bromides at all accessible 
points of the mucous membrane, and of the skin — notably of the plan- 
tar surfaces of the hand and foot. The diminution of the sensibility 
of the mucous membranes is in part due to a local action of the salt 
as it is being eliminated. 

Motility is impaired by the long-continued use of the bromides in 
man, and in animals paralysis of the muscles ensues. If injected into 
the tissues of a limb, paralysis of motion and sensibility begins in that 
member. In man the impaired motility is probably due to other fac- 
tors as well as to the action of the bromides on the muscular tissue, 
viz., to the cutaneous anaesthesia, and to an anaemia of the co-ordi- 
nating centers, in consequence of which their functional power is 
lowered. 

A very notable effect of the bromides — chiefly bromide of potas- 
sium — is the diminution of the sexual feeling and of the power of 
erections produced by it. This fact has been established by abundant 
clinical evidence. The result is not, however, produced with equal 
facility in all cases, and considerable doses are necessary in any case. 

Prolonged administration of the bromides develops a peculiar state, 
to which the term bromism is applied. This condition of chronic poi- 
soning differs from the effects of a few medicinal doses in the extent 
and intensity, but not in the character, of the symptoms. The follow- 
ing were the symptoms of bromism, as observed in an epileptic boy, to 
whom two drachms of the bromide of potassium had been administered 
daily for a month : extreme pallor and anaemia, dilated pupils, acne on 
face, forehead, and shoulders ; a fetid, bromine breath ; slow and 
feeble action of the heart ; breathlessness, and quickened pulse on 
slight exertion ; cool hands and feet ; a general subjective sense of 
coldness ; movements in walking tremulous and uncertain ; diminu- 
tion of the tactile sensibility of both cutaneous and mucous surfaces ; 
fauces dry, and the reflex movements sluggish ; swallowing somewhat 
difficult ; antaphrodisia and complete relaxation of the genitals ; mind 
weak, manifested in silly conduct and unmeaning laughter. 



BROMIDES. 541 

Various mental symptoms are in some subjects produced by the 
long-continued use of the bromides. Weakness of mind, without per- 
version of intellection, is a very constant result of the continued use 
of large doses. Headache, confusion of mind, and a sort of intoxica- 
tion, had long ago been observed to follow the use of the bromide of 
potassium in even moderate doses (Puche). A form of mental de- 
rangement, with hallucinations of a melancholic character, has been 
observed by Hammond and others, and in a few instances a pleasura- 
ble intoxication, with exalted ideas, has been produced. 

The pallor and anaemia of bromism are due to several causes : to 
the diminished action of the heart ; slowness of the capillary circula- 
tion, and consequent interference in the metamorphosis of tissue ; de- 
rangement of digestion and assimilation in consequence of gastric ca- 
tarrh ; and diminished blood-supply to the cerebro -spinal axis. The 
disorders of voluntary movement, the uncertain gait, the apparent 
defects of co-ordination, are variously explained ; but, they are doubt- 
less made up of several factors, of which the cutaneous anaesthesia is 
the most influential. The bromides possess the power to destroy or 
impair the irritability of the motor and sensory nerves, and the con- 
tractility of muscle, and to these effects must be attributed in part the 
disorders of voluntary movement noted above. 

It is very obvious that the bromides depress certain organic func- 
tions : they diminish the action of the heart, lower the animal tem- 
perature, and lessen the blood-supply to various organs. These re- 
sults can only be accomplished by a sedative influence on the sympa- 
thetic system. Some very accurate observers have maintained that in 
this action lies all of the physiological power of the bromides (Rey- 
nolds, Amory). 

Effects of the Bromides compared. — There is a general corre- 
spondence in the actions of the different bromides. As respects their 
influence on the pulse, body-heat, and respiration, the author's com- 
parative experiments have demonstrated that these agents stand to 
each other in the following order : bromide of sodium, bromide of 
lithium, bromide of potassium, bromide of ammonium. Very notable 
differences exist between the bromide of ammonium and the others, 
due, undoubtedly, to the character of the base. 

The author's experiments on animals further demonstrated the fol- 
lowing : bromide of potassium possesses the most toxic power, and 
bromide of sodium the least. The bromide of lithium is first, the 
bromide of sodium second, and the bromide of potassium third, in 
hypnotic power. As respects the influence of these agents severally 
on the reflex faculty of the spinal cord, it may be stated that none of 
them possess the power to abolish the reflex faculty except when ad- 
ministered in sufficient quantity to produce lethal effects. Consid- 
ered from this point of view, the bromides may be grouped as fol- 



542 CEREBRAL SEDATIVES. 

lows : bromide of ammonium, bromide of potassium, bromide of lith- 
ium, bromide of sodium. 

The elimination of the bromides takes place through the mucous 
membrane of fauces, intestinal canal, and bronchi, through the skin, 
but chiefly by the kidneys. The rate of elimination varies, but is 
usually slow, several days being occupied in its diffusion outwardly 
from the blood. 

Therapy. — In some kinds of vomiting the bromides are most ser- 
viceable. The form of vomiting, to the treatment of which they are 
adapted, is that of cerebral origin ; e. g., the vomiting of cerebral con- 
gestion, sea-sickness, the vomiting of pregnancy, etc- They are con- 
traindicated in all cases of vomiting due to primary gastric disturbance. 

Remarkable improvement not unfrequently results from the use of 
bromide of potassium in cholera infantum. It is difficult to define the 
precise conditions under which this agent is successful ; but, accord- 
ing to the author's observation, it is useless, if not injurious, when de- 
fective alimentation is the cause of the attacks, and is serviceable 
just in proportion to the degree in which an irritable state of the 
nervous system dominates the gastro-enteric disturbance. When the 
cause of the attacks is heat, or reflex irritation of the fifth pair, as in 
teething, or cerebral congestion, very excellent results are obtained 
from the use of the bromide of potassium. ^ Potassii bromidi, 3 ij ; 
syrup, simplicis, § ss ; aquae menthae pip., 5 jss. M. Sig.: A teaspoon- 
ful every hour or two. The author has had excellent results from the 
use of the bromides in the flatulent colic, the restlessness, and crying 
fits, of infants. I> Potassii bromidi, 3 j ; ol. anisi, ni ij ; mucil. acaciaa, 
aquae menthae pip., aa § j. M. Sig. : A teaspoonfal every half hour 
until relief is experienced. 

Increased action of the heart (hyperkinesis) due to irritation of the 
sympathetic, as, for example, such as occurs in exophthalmic goitre, is 
calmed by the bromides. The irregular and too frequent action of the 
heart, occurring in hysterical subjects of plethoric constitution, is 
generally relieved in the same way ; but the bromides are contraindi- 
cated in all cases dependent on anaemia. Disturbed action (overac- 
tion) of the heart, with cerebral hyperaemia, is frequently most ad- 
vantageously treated by a combination of digitalis and a bromide : ty 
Inf. digitalis, § iv ; potassii bromidi, f ss — § j. M. Sig. : A table- 
spoonfid morning and evening. 

Da Costa has, in several publications, strongly urged the use of 
the bromide of ammonium in acute rheumatism. Doubtless, other 
bromides (potassium, sodium, lithium) would be as effective, and are 
certainly much less disagreeable. The author has used the bromide of 
lithium with considerable apparent success, in subacute rheumatism, in 
rheumatic gout, and to remove the stiffness and nodosities of joints re- 
maining after attacks of the above-named rheumatic affections. The 



BROMIDES. 543 

wakefulness, delirium, and hyperpyrexia, which sometimes complicate 
rheumatism and gout, are best treated by bromide of lithium, pain 
being relieved by morphine if necessary. 

It has been stated that the bromides, especially bromide of ammo- 
nium, diminish the deposition and hasten the retrograde metamorphosis 
of the fat in obesity. Undoubtedly these agents increase waste, but 
they do so, chiefly, in consequence of a severe gastric catarrh which 
they set up. 

Rabuteau has proposed the use of the bromides as eliminating 
agents in cases of mercurial, cupric, or saturnine poisoning. These 
agents, more efficiently than the iodides, combine with the deposited 
minerals, convert them into soluble combinations, and thus cause their 
elimination. The best results are probably obtained by a combination 
of the bromide and iodide of potassium. 

The most important therapeutical applications of the bromides of 
potassium, sodium, lithium, etc., are in the treatment of cerebral dis- 
orders from overaction. The bromides acting on the heart slow its 
movements, and, on the vaso-motor nerves, diminish the intra-cranial 
blood-supply. The best results are obtained in the treatment of cases 
in which there is no ansemia on the one hand, or inflammatory re- 
action on the other ; cases in which the intra-cranial blood-supply is 
in excess, because the vaso-motor regulating centers are wanting in 
activity. The most typical representation of this condition is seen in 
wakefulness from cerebral overwork. No clinical fact is more con- 
spicuous than that the bromide of potassium will relieve wakefulness 
of this kind. The hypnotic action of the bromides is not a certain 
action like that of chloral, nor like that of morphine under appropriate 
conditions ; considerable mental excitement and an active cerebral 
congestion may entirely prevent the hypnotic effect. Wakefulness 
from mental worry, fatigue, unrest of the peripheral nerves (fidgets), 
and similar causes, will generally be relieved by the bromides. For 
this purpose a cumulative action is generally desirable, effected by giv- 
ing a dose of fifteen grains before each meal, and one of thirty grains 
on retiring. The manner in which the hypnotic action of the bromides 
is limited by certain states of the intra-cranial circulation is well ex- 
hibited in delirium tremens. In the condition of nervous excitement 
and wakefulness which precedes the delirium, and which is known as 
" horrors," the action of the bromide is most satisfactory ; it quiets 
the restlessness and induces sleep. For this purpose considerable 
doses are necessary — a drachm every four to six hours. When, how- 
ever, delirium tremens is fully developed, this remedy is much less 
efficient, and frequently fails altogether to produce sleep. It is more 
serviceable in the first than in subsequent attacks of horrors, and its 
utility diminishes as the structural alterations of chronic alcoholismus 
increase. 



544 CEREBRAL SEDATIVES. 

In some cases of maniacal excitement the bromides produce excel- 
lent effects, but they very frequently fail without apparent reason. 
In acute mania accompanied by heat of head, injected conjunctivae, 
and restlessness, refreshing sleep may follow the administration of one 
full dose ; but the remedy fails more frequently than it succeeds. In 
puerperal mania of the sthenic form, with rather quick and full pulse, 
hot head, and injected conjunctivae, the author has witnessed excellent 
results from the use of the bromide of potassium ; but it has rather 
increased the delusions and the depression when the type of the case 
was melancholic, with systemic weakness and anaemia. A similar ex- 
perience has been had in the use of the bromides in hypochondriasis 
and melancholia. These forms of mental trouble are most usually 
accompanied by bodily weakness, and are rather increased by the use 
of the bromides ; but it occasionally happens that these agents give 
an amount of relief afforded by no other drug or combination of 
drugs. It is impossible to indicate, in the present state of our knowl- 
edge, the particular cases in which the bromides may be serviceable, 
but the author ventures to express the opinion that the state of the 
intra-cranial circulation, which may be ascertained on ophthalmoscopic 
examination, will furnish the true guide. It need hardly be ob- 
served that the bromides are useless when wakefulness is dependent 
on pain. 

Some kinds of neuralgia are much benefited by the bromides. The 
congestive form of migraine, or sick-headache, is generally quickly 
dispelled by one or more full doses. The form of migraine in which 
it acts almost as a specific is that characterized by a flushed face, 
throbbing temples, injected conjunctivae, eyes intolerant of light. The 
bromides often give great relief in the fugitive nerve-pain of hysteri- 
cal women ; but they are quite ineffectual in neuralgia fixed in a 
nerve, as, for example, in trigeminal neuralgia, sciatica, etc. The 
bromide of potassium is often quite successful in ovarian neuralgia, 
and in the nervous unrest which grows out of ungratified sexual in- 
stinct in men and women. 

Very remarkable results have been obtained by the use of large 
doses of bromide of potassium in tetanus. H. C. Wood gives a tabular 
statement of fifteen cases which he has collected, in which the bromide 
of potassium was the chief or the only agent used, and of these but 
two died. No results equal to this have been achieved by any other 
agent, not even by Calabar bean. In order to succeed with this 
remedy it must be given in large doses ( 3 j every three or four hours). 
A combination with chloral is also highly effective, but these agents 
exert a powerfully depressing action on the heart. 

Cases of strychnine-poisoning have been reported cured by full 
doses of the bromide of potassium. One case is narrated by Dr. 
Gillespie in which three grains of strychnine were taken, and the lethal 



BROMIDES. 545 

effects were obviated by one ounce of bromide of potassium in divided 
doses. 

No therapeutical fact is better established than the influence of 
bromide of potassium over epilepsy and epileptiform seizures. But 
the curative power of this agent in epilepsy has numerous limitations. 
It has been well ascertained that bromide of potassium is most valu- 
able in those cases of epilepsy characterized by frequent and violent 
convulsive seizures. Epileptiform attacks, dependent on the presence 
of a tumor or other coarse organic lesion of the brain, are usually 
suspended by the use of this agent, although the neoplasm is un- 
affected in its growth and development. It is a curious circumstance 
that attacks, nocturnal exclusively, are less amenable to the bromide- 
treatment than those which occur in the daytime. 

Cases of the petit mal, or epileptoid seizures, in which there is tempo- 
rary loss of consciousness without convulsion, or with a transient spasm 
of the facial muscles, etc., are as a rule not so much benefited as are 
cases of the grand mal. Hysterical convulsions (hystero-epilepsy) are 
benefited by the bromide in the degree in which they partake of the 
nature of true epilepsy. Simple hysterical convulsions are rarely im- 
proved even by a course of this medicine. It has been repeatedly 
shown, as was first observed by Sir Charles Locock, that the bromides 
are especially eflicacious in cases of epilepsy of sexual origin. 

Although the bromide of potassium is less effective in the epilepsy 
of childhood than of adults, it is an excellent remedy in infantile con- 
vulsions dependent on reflex irritation. After the removal of the irri- 
tation the convulsive attacks may continue, but they can be arrested 
by the use of the bromides. The cerebral congestion which precedes 
the convulsive seizure may be relieved by this agent, and the threat- 
ened attack averted. The author is convinced that the convulsions 
which attend tubercular meningitis may be prevented by the bromide, 
but this agent exerts no curative influence in this fatal malady. 

In the present state of our knowledge it is not possible to indicate 
with any degree of certainty, besides the points mentioned above, the 
kind of cases in which a successful result may be expected from the 
bromide treatment. If no improvement be manifest after several 
weeks of treatment, and if bromism be induced, the case must be re- 
garded as an unfavorable one for this treatment. Brown-Sequard 
thinks that the cropping out of an " acne-like eruption on the face, 
neck, shoulders," etc., is an evidence that the bromide is proving cura- 
tive, and he even asserts that there is "a positive relation between 
the intensity of the eruption and the efficacy of the remedy against 
epilepsy." According to Yoisin, the abolition of reflex nausea — ascer- 
tained by passing a spoon as far back as the epiglottis, without causing 
attempts at vomiting — is an indication of the successful action of the 
remedy. Furthermore, he regards the following physiological effects 
35 



546 CEREBRAL SEDATIVES. 

as evidence of curative power : " Hypnotic manifestations, general las- 
situde, an easy and rapid disappearance of reflex nausea, and antaphro- 
disiac action." 

Certain cases of epilepsy, in which the bromide of potassium fails to 
afford relief, are greatly benefited by strychnine. From this circum- 
stance it has been concluded that the former agent is most serviceable 
in cases in which a condition of hyperemia of the brain exists, and 
that the latter agent produces the best effects when a condition of 
cerebral anaemia is present. 

Various important considerations are connected with the adminis- 
tration of the bromides in epilepsy. The daily dose required varies 
from half a drachm to four drachms, the limit of the quantity admin- 
istered being determined by the effect produced. The occurrence of 
bromism and the arrest of the seizures are the evidences that a suffi- 
cient quantity has been introduced into the organism. According to 
the author's experience, forty grains of the bromide, dissolved in water 
and given before each meal, or three times a day, and if required a 
double dose at bedtime, is an amount of the medicine which it is rarely 
necessary to exceed. When the convulsive attacks have ceased, a sin- 
gle dose of sixty grains at bedtime will generally suffice ; but this re- 
sult must not be interpreted too favorably, and the remedy discon- 
tinued, for an immense experience has now demonstrated that security 
against a return of the attacks can only be attained by a continuance 
of the remedy for two or more years after all indications of epilepsy 
have disappeared. After the continuous use nightly of the remedy 
for a year, the dose may be so far diminished as to give it on alternate 
nights. Should the attacks recur after temporary cessation, larger 
doses are required as a rule. 

The long-continued use of the bromide of potassium may produce 
very serious symptoms of bromism. The remedy must then be greatly 
reduced in amount or be discontinued, and tonics and restoratives ad- 
ministered until the organism recovers its tone. When there is much 
susceptibility to the action of the bromides, it is generally better to 
prescribe the bromide of sodium. This salt is equally effective in epi- 
lepsy, while it is much less depressing in its effects. It is not unfre- 
quently desirable to administer iron during a course of bromides. The 
author has had excellent results from the following : ^ Potassii bro- 
midi, | j ; ferri bromidi, gr. vj ; aquae, § vj. M. Sig. : A tablespoon- 
ful three times a day. Echeverria has made the observation that tak- 
ing strong coffee with the meals hinders the development of bromism. 
The troublesome and very disfiguring acne may be, in part at least, 
prevented by the conjoined administration of arsenic (three to five 
drops of liq. potassii arsenitis). Brown-Sequard, with that fondness 
for complex combinations which he has always exhibited, recommends 
the following formula for epilepsy : ^ Potassii bromidi, § j ; ammo- 



BROMIDES. 547 

nii bromidi, 3 ijss ; potassii iodidi, 3j; potassii bicarb., 3ij ; infus. 
calumbae, 3 vj. M. Sig. : A teaspoon fid before each meal, and three 
teaspoonfuls at bedtime. There is probably no advantage in this com- 
bination, and it is execrable as regards taste. It is true sometimes 
better results are obtained from a combination of bromides than from 
the bromide of potassium alone. It is always advisable to combine 
the iodide of potassium with the bromides, when there is reason to 
suspect syphilitic cerebral lesions, or when degenerate changes may 
appear to be taking place. 

Vaso-motor disturbances, elsewhere than intra- cranial, are relieved 
by the bromides. " Such symptoms are, for example, sudden numb- 
ness, coldness, deadness, or pricking sensations in one or more limbs ; 
sudden distressing but indefinable feelings in the epigastrium, abdo- 
men, or hypogastrium ; or sensations akin to rigor, with much anxiety 
and palpitation, or ' fluttering,' of the heart. In such cases it may be 
observed that the local circulation is interfered with ; that, for exam- 
ple, the pulse in one arm becomes faltering, irregular in force and 
rhythm, occasionally intermitting, while that in the other arm may 
remain unaltered, and the beat of the heart may maintain its normal 
character." 

The painf id flushings of the face, and the sense offidlness in the 
head, which occur so frequently at the climacteric period in women, 
may often be removed by the bromides. 

Certain of the respiratory neuroses are greatly relieved by the 
bromides. Laryngismus stridulus, when present, may be suspended 
by the prompt use of full doses, and the tendency to frequent recur- 
rence of the attacks obviated by the steady and continued use of mod- 
erate doses of this remedy. It may be combined with chloral : $ 
Potassii bromidi, 3 ij ; chloral, hydratis, 3 ss ; syrup, tolu,, § ss ; aquae, 
I jss. M. Sig. : A teaspoonful every half -hour. The bromides greatly 
relieve the spasmodic element of whooping-cough, but they do not ap- 
pear to shorten the duration of the disease. A combination such as 
given above, for a child of two years, may be prescribed in whooping- 
cough during the spasmodic stage, and in proportionally larger quan- 
tity for older children. 

In spasmodic asthm a very great relief is sometimes afforded by the 
use of bromides, but these remedies lose their effect very quickly. 
The best results are obtained from a combination of the bromide with 
the iodide of potassium : 3 Potassii bromidi, | j ; potassii iodidi, f ss ; 
aquae, § iv. M. Sig. : A teaspoonful in sufficient water every half- 
hour or hour. 

Cough which is merely reflex (stomachal, intestinal, renal, uterine, 
ovarian) can usually be cured by the bromides. It is said that a gar- 
gle of the bromide of potassium will diminish the cough of phthisis. 
The author has ascertained that it is only occasionally that such a for- 



548 CEREBRAL SEDATIVES. 

tunate result can be achieved in this way. Such a diminution of the 
sensibility of the fauces can be produced by a few large doses of the 
bromide of potassium, that this expedient has been proposed to facili- 
tate laryngoscopy and rhinoscopy. 

In certain neuroses of the genito-urinary organs, male and female, 
excellent results have been obtained by the use of the bromide of potas- 
sium. Abnormal sexual excitement and nocturnal seminal emissions 
may be checked by this remedy. The condition of plethora is the in- 
dication for the bromide. "When the sexual organs are much relaxed, 
the erections feeble, and the seminal fluid watery, especially if there 
be such a constant stillicidium of semen as to constitute the so-called 
diurnal losses, the bromide of potassium does harm. The more nearly 
nocturnal seminal losses approach the physiological type, the more 
effective the bromides. As they act by diminishing the blood-supply 
to the erectile organs, it is obvious that they are contraindicated when 
there is debility, and when the erections are feeble. They prove com- 
pletely successful when the erections are normal as to character, but 
teasing and persistent. The various nervous disturbances growing 
out of unsatisfied sexual desire are quieted by these agents. As a 
rule, nymphomania and satyriasis dependent on cerebral lesions are 
not diminished or prevented by the bromides. 

Bromide of potassium, in full doses, has been proposed for the 
relief of chordee. The result is generally disappointing, but occa- 
sionally relief is experienced from it. Very large doses ( 3 j every 
four hours) are necessary. 

Menorrhagia, dependent on ovarian irritation, is usually promptly 
arrested by these agents. Sometimes metrorrhagia, even when due to 
a fibroid, is remarkably improved by their use, but success is not in- 
variable. 

Various functional nervous disorders associated with, or dependent 
on, derangements of the sexual system — for example, such as are 
grouped together under the term spinal irritation — are treated with 
occasional success by the bromides. It is to be noted, however, that 
a condition of general anaemia or local spinal anaemia, which usually 
coexists, is a contraindication to the use of these agents. They are 
useful in proportion to the degree of plethora present. 

Local Uses of Bromides. — Epithelioma of the face has been 
cured by applying to the ulcerated surface bromide of potassium in 
fine powder. A solution, gr. x — gr. xx to an ounce of water, is a 
useful application for allaying the itching in pruritus, prurigo, and 
similar conditions, and the powder dusted over the surface is an effec- 
tive remedy for eczema, old ulcers, etc. 

Acidum Hydeobromictjm Dilutum. — Diluted hydrobromic acid. 
A liquid composed of ten per cent of absolute hydrobromic acid 
and ninety per cent of water. A clear, colorless liquid, odorless, hav- 



BROMIDES. 549 

ing a strongly acid taste, and an acid reaction. (IT. S. P.) Dose, ttj, xx 
-3ij. 

Hydrobromic acid has many of the properties of the bromides, and 
can therefore be substituted for the latter in some cases. In the treat- 
ment of epilepsy, the acid is far inferior to the bromides. In spas- 
modic cough it has proved very useful. In angina pectoris, or cardiac 
irregularities due to acidity of the stomach, it is highly useful, given 
before meals. The tinnitus, dizziness, and headache caused by quinine 
may be largely diminished, if not wholly prevented, by the addition of 
hydrobromic acid to the solutions containing the former, or by giving 
the latter some time after. The after-nausea and depression caused 
by morphine may be obviated by the simultaneous or subsequent ad- 
ministration of hydrobromic acid. 

Authorities referred to : 

Anstie, Dr. F. E. Neuralgia and the Diseases that resemble it, English edition, 
p. 185. 

Bartholow, Dr. R. TJie Bromides : their Physiological Effects and Tlierapeuiical Uses, 
Fisk-Fund Prize, Providence, 1871. 

Bill, Dr. J. H. American Journal of the Medical Sciences, July, 1868. 

Browne, Dr. J. C. The Action of the Bromide of Potassium on the Nervous System. 
Pamphlet. 

Brown-Sequard, Dr. C. E. Functional Nervous Affections, Part i, p. 35. 

Clarke and Amort. The Physiological and Therapeutical Action of the Bromide of 
Potassium and the Bromide of Ammonium, Boston, 1872. 

Da Costa, Dr. J. M. American Journal of the Medical Sciences, April, 1871. 

Damourette et Pel vet. Bulletin General de Therapeutique, vol. lxiii, p. 296. 

Day, Dr. Albert. Methomania, Boston, 1867, p. 30. 

Echeverria, M. Gonzales. On Epilepsy, p. 316. 

Eulenburg und Guttmann. Schmidt 's Jahrbucher der gesammten Medicin, vol. 
cxxxvii, p. 158. 

Gillespie, Dr. Charles. American Journal of the Medical Sciences, October, 1870. 

Hammond, Dr. William A. On Wakefulness. 

Ibid. The Psychological Journal. 

Laborde, Dr. J. V. Archives de Physiologie Normale et Pathologique, May, 1868. 

Lewizky, aus Kasan. Virchow's Archiv fur pathologische Anatomie, 1868, p. 183. 

Pletzer, M. Schmidt's Jahrbucher der gesammten Medicin, Band cxxxix, p. 166, No. 
8, 1868. 

Rabuteau, M. Gazette Hebdomadaire, March 19, 1868. 

Reynolds, Dr. J. Russell. The Practitioner, July, 1868. 

Voisin, A. Bulletin General de Therapeutique, vol. lxxi, p. 102. 

Williams, Dr. S. W. D. On the Efficacy of the Bromide of Potassium in Epil 
etc., Churchill, 1865. 



550 MOTOR DEPRESSANTS. 



AGENTS WHICH DEPRESS THE MOTOR FUNCTIONS 
OF THE SPINAL CORD AND SYMPATHETIC. 

Conium. — Hemlock. The full-grown fruit of Conium maculatum 
Linne (Nat. Ord. Umbelliferce), gathered while yet green. (U. S. P.) 
' Cigue, Fr. ; Schierling, Ger. 

Abstractum Conii. — Abstract of conium. Dose, gr. ss — gr. ij. 

Mctractum Conii Alcoholicum. — Alcoholic extract of conium. 
Dose, gr. j — grs. v. 

Extractum Conii Fluidum. — Fluid extract of conium. Dose, 

TTi ij — TIJ, V TTl Xl. 

Tinctura Conii. — Tincture of conium. Dose, t\[ x — 3 j. 

The preparations of conium are very uncertain in strength. It is 
pretty well established that the extracts are nearly, if not quite, inert. 
The best preparations are the fluid extract and alkaloid. 

Composition. — The special powers of hemlock are due to a pecul- 
iar alkaloid (conine). This is an oily, limpid liquid, having a strong 
alkaline reaction, a peculiar odor resembling the urine of mice, and a 
specific gravity of 0*88. It probably exists in the plant in the form of 
the malate ; but, by some authorities, the acid with which it is com- 
bined is supposed to be an acid peculiar to conium, the coneic acid. 
Conine is associated with ammonia, and another crystallizable alkaloid, 
conhydrine. 

Conine is quickly decomposed by beat. Exposed to the air, it is 
soon converted into a brownish resin, and becomes inert. Hence it is 
that the preparations of conium possess but little activity, and are so 
frequently, indeed entirely, wanting in physiological and therapeutical 
effects. It is better, therefore, to administer the alkaloid, which, be- 
ing soluble in alcohol, may be administered in that menstruum, or it 
may be converted into an acetate and dissolved in a mixture of alco- 
hol and water. It is to be noted, also, that different specimens of 
conine differ remarkably in activity ; hence, whenever a new prepara- 
tion is begun, the minimum dose should be first administered until its 
real power is ascertained (Burman). 

Conine. — Dose, gr. -fa — gr. fa — gr. fa , or in minim-doses from tq, fa 
— tii ij« Half a minim of conine (pure) is about equivalent in activ- 
ity to f j of the best succus conii. The chlorhydrate and especially 
bromhydrate of conine are greatly to be preferred, not only to the pure 
alkaloid, but to any of the preparations of conium. The bromhydrate 
crystallizes in the form of colorless, prismatic needles, which are freely 
soluble in water and also in alcohol, have but little taste, and no odor 
(Mourrut). The dose of this salt ranges from fa of a grain to J, -J, 
even 1 grain. It is not actively toxic. By reason of this fact, its 
freedom from a disagreeable taste or odor, and its solubility, the brom- 



CONIUM. 551 

hydrate is a most desirable preparation for administration, either by 
the stomach or hypodermatically. 

Antagonists and Incompatibles. — The caustic alkalies and tannic 
acid are chemically incompatible. Physiologically considered, the ac- 
tions of conium are antagonized by nux-vomica and its alkaloids strych- 
nine and brucine, by picrotoxin, and the tetanizing agents in general. 

Synergists. — Gelsemium, tobacco, veratrum viride, aconite, me- 
thyl-strychnium, hydrocyanic acid, and curara, increase the action of 
conium. 

Physiological Actions. — The preparations of conium possess a 
considerable degree of acridity, and are therefore apt to produce gas- 
tric irritation, nausea, and vomiting. These results sometimes follow 
the subcutaneous injection of conine. The active principles readily 
diffuse into the blood. What changes, if any, they induce in the blood 
are quite unknown. It is probable that they limit the power of the 
red blood-globules to convey oxygen to the tissues on which they have 
a selective action — the motor nerves. 

When an active dose of conine is administered, weakness of the 
legs and a sense of weight and fatigue of these members are first 
experienced. The eyelids become heavy and droop somewhat, and 
double vision, or confused vision, a feeling of torpor of the mind, and 
giddiness, follow. Speech is also affected as respects vocal utterance, 
but the memory for words and the faculties of mind generally are un- 
impaired. When the dose is a lethal one, paralysis of the voluntary 
muscles — first of the inferior extremities — ensues ; there is consider- 
able vertigo, the mind is torpid and indifferent but not perverted, 
speech and vision are lost, the respiration becomes labored and slow 
from paralysis of the respiratory muscles, and death occurs from as- 
phyxia, the action of the heart continuing until after respiration has 
ceased. The mind remains unclouded to the last, except when delirium 
ensues from carbonic-acid poisoning. Convulsive movements generally 
occur in animals from retention of carbonic acid in the blood, and in 
man sometimes local convulsive movements. Sensation is unaffected 
until near the close, but a subjective sense of numbness is experienced 
in the feet and legs, without actual impairment of the functions of the 
sensory nerves. The body temperature is decidedly lowered, and in a 
direct ratio to the amount of the paralysis. 

The physiological effects of conine, even when produced by decid- 
edly large medicinal doses, are hindered if not entirely prevented by 
active exercise. When the muscular weakness, the heaviness and 
sense of fatigue in the legs are first experienced, if resisted and muscu- 
lar movements are carried on, these sensations disappear, and the 
whole duration of the physiological effects is much shortened. 

The action of conine is, primarily and chiefly, on the end-organs of 
the motor nerves ; the nerve-trunks next lose their excitability, and 



552 MOTOR DEPRESSANTS. 

by an extension of the paralysis the spinal cord is at last involved. 
The muscular irritability remains unaffected. According to M. Veri- 
go, the paralysis proceeds from the spinal cord, outwardly, to the ter- 
minal filaments of the motor nerves. But it is probable that this 
experimenter operated with a preparation of conine containing methyl- 
conium, which has been shown, by Crum Brown and Fraser, to affect 
first the motor columns of the spinal cord. 

No constant and characteristic post-mortem appearances seem to 
be produced by conine. The left cavities of the heart are found empty, 
and the right distended, but these are products of the mode of dying, 
and are not directly due to the action of the poison. The blood is 
generally fluid, and the coagula are soft. 

Elimination takes place by various channels, chiefly by the kidneys. 
Conine has been found in considerable quantity in the liver, lungs, and 
spleen. 

Therapy. — Formerly the preparations of conium were much used 
for a supposed discutient or resolvent action in glandular enlargements, 
and in certain hinds of tumors. But, since it has been shown that the 
preparation chiefly employed for this purpose (the extract) is practi- 
cally inert, the supposed cures effected in this way are justly regarded 
as examples of the post hoc. Influenced by the same considerations, 
conium was supposed to have an alterant and anodyne action in cancer. 
But, since, in the progress of physiological research, it has been shown 
that conium affects the motor and not the sensory nerves, it is no longer 
employed to relieve the pains, or to arrest the growth and diffusion, of 
cancer. It is right to add, however, that able practitioners hold that 
the discutient and resolvent powers of conium are well established in 
clinical experience (Stille). 

The true uses of conium are those deduced from a consideration of 
its physiological actions. As it lowers the functional activity of the 
motor nervous system, it is indicated in those cases of disease in which 
motor activity is in excess. Very valuable results have been obtained 
by the use of conine in mania, administered with the view of subduing 
excessive motor excitement. Its real utility consists in quieting mus- 
cular agitation, and thus preventing emaciation and maniacal exhaus- 
tion. It is considered to be most suitable to the treatment of acute 
mania, without organic brain-lesion (Burman). The dose required for 
this purpose is th, ss — tti iij, or subcutaneously, commencing with one 
tenth of a minim, and gradually increasing it until some characteristic 
physiological effects are produced. 

The succus conii has been used by Harley and others with success 
in chorea. The special object for which it is used in this malady is to 
quiet the excessive muscular agitation ; but, in order to accomplish 
this result, a sufficient quantity must be administered to produce distinct 
physiological effects. To quiet muscular agitation is not alone suffi- 



CONIUM. 553 

cient to cure chorea ; a suitable hygiene, proper alimentation, and re- 
storative agents, are indispensable. Some cases of paralysis agitans 
are remarkably benefited by conium, but it is of little avail in cases of 
sclerosis, or when important structural alterations have occurred. Co- 
nine is certainly indicated in tetanus, hydrophobia, and strychnine- 
poisoning, but hitherto it has not succeeded, probably because in- 
ert preparations were employed. The author has ascertained that 
in animals conine rather hastens than retards the lethal effects of 
strychnine. 

In whooping-cough, asthma, and laryngismus stridulus, good effects 
have been obtained by the use of conium, carried to the point of in- 
ducing its characteristic physiological effects. A priori, the best re- 
sults might be expected from the use of conium in epilepsy, but it is 
by no means comparable to the bromides. According to Echeverria, 
conium is serviceable in those cases of epilepsy " attended by cerebral 
derangement and vertigo." 

The state of blepharospasm, which accompanies strumous ophthal- 
mia, is relieved by considerable doses of conium. It is necessary in 
the treatment of this, as of other motor disorders, to give a sufficient 
quantity of conium to produce sensible physiological effects. 

The Hypodermatic Use of Conine. — The alkaloid itself is much too 
irritant for subcutaneous use. The local inflammation which it sets up 
prevents absorption, and hence the effects are nil. The alcoholic solu- 
tion is almost equally objectionable. The following formula, proposed 
by Bur man, is the best for the subcutaneous use of the alkaloid : 

5 Coninse, 3 iij, V{ xij. 

Acidi acetic, fort., 3 iij, f\[ xij. 
Spts. vmi rect., 3 j. 
Aquae destillatae ad § ij. 
M. Sig. : Dose, one minim to begin with, and gradually increase as necessary. 
Five minims of this solution contain one minim of conine. 

" The acid must be added carefully and gradually until neutraliza- 
tion, or as near an approach to it as possible, is attained ; litmus-paper 
being used, from time to time, to determine the reaction." Different 
specimens of conine may require somewhat different proportions of 
acid to neutralize it. If the mixture be turbid after the addition of 
the spirit and water, a little more spirit may be added. 

The subcutaneous injection of conine may be practiced instead of 
the stomach administration, in all of the forms of disease for which 
this remedy is prescribed. By Burman this mode of administration 
has been practiced with much success in the treatment of acute mania ; 
by Pletzer, in asthma ; by Erlenmeyer, in .emphysema and angina pec- 
toris ; by Lorent, in pneumonia and pleuritis ; and by Eulenburg, in 
blepharospasm. A marked decrease in the pulse-rate, and in the tern- 



554 MOTOR DEPRESSANTS. 

perature, has been observed to follow the hypodermatic injection of 
conine in these diseases. The rational indication for the use of conine 
in pneumonia and pleuritis is, to give the organs physiological rest by 
inducing a paretic state of the respiratory muscles. 

A solution of bromhydrate of conine is greatly preferable to any form 
of the alkaloid, for all purposes, but especially for subcutaneous injec- 
tion. The following will prove useful : $ Coninae bromhydratis, gr. 
viij ; aquae, vel aquae lauro-cerasae, J j. M. Sig. : Ten minims con- 
tain one sixth of a grain. As Tiryakian and also Tuloup have shown, 
the effect of this agent declines by repetition, and hence the dose must 
be increased every few days. Two doses every twenty-four hours will 
usually be sufficient to maintain a constant effect. By the authors 
above mentioned, by Dujardin-Beaumetz, Prevost, Rochefontaine, and 
others, it is asserted to be very effective in spasmodic affections, espe- 
cially of the respiratory organs — in whooping-cough, asthma, dyspnoea, 
laryngismus stridulus, spasm of the glottis, hiccough, etc. It has been 
used with success in tetanus by Chisolm and by Cory. 

Conine and Morphine. — The effects of conine are in every way 
heightened by morphine. These agents have been very successfully 
employed in acute mania, conjointly administered subcutaneously. 
" Conine acting on the purely motor centers, in a sedative manner, 
and morphine acting in a similar way on the sensori-motor and ideo- 
motor centers, it follows, as a fair corollary, that the combination of 
the two, in subcutaneous injection, should lead to effects directly an- 
tagonistic to the condition of maniacal excitement ; and, such being 
in fact the case, they may be thus used together with very great suc- 
cess in the treatment of mania." When nerve-pain and muscular 
spasm coexist, the best results may be expected from the combined 
administration of morphine and conine. 

Authorities referred to : 

Burman, Dr. J. Wilkie. West Riding Lunatic Asylum Reports, vol. ii, p. 1. 
Curtis, Dr. Edward. The Medical Record, Nos. ccxxxvii, ccxxxviii, 1875. 
Erlenmeyer, Dr. A. Die subcutanen Injectionen, p. 74. 
Eulenburg, Dr. A. Die hypodermatische Injectionen, p. 239. 
Fluckiger and Hanbury. Pharmacographia, p. 266. 
Harley, Dr. John. Old Vegetable Neurotics, English edition, etc. 
Husemann, Dr. Theodor. Handbuch der gesammten Arzneimittellehre, zweiter Band, 
p. 925. 

Husemann, Drs. Theod. und Aug. Die Pfianzenstoffe. 

Kolliker, Prof. Dr. A. Virchow's Archiv, Band x, p. 228. 

Lorent, Dr. E. Die hypodermatischen Injectionen, p. 42. 

Pelvet et Damourette. Archives Generates, sixieme serie, tome vi, p. 87. 

Peltzer, M. Quoted by Eulenburg, supra. 

Taylor, Dr. A. S. On Poisons, third edition, p. 731. 

Von Praag, L. Schmidt's Jahrbucher der gesammten Medicin. 

Verigo, M. The Practitioner, vol. vii, p. 58. 



CURARA. 555 

Curara, or Woorara. 

History. — There are no official preparations. The substances 
known under this name vary much in purity, and differ in origin. 
True curara is a poisonous substance, prepared by the Indian tribes of 
certain districts of South America, and known under the names woo- 
rara, urari, wurali, etc. A specimen examined by Mitchell and Ham- 
mond consisted of two distinct preparations named respectively carro- 
val and vao, the former more closely corresponding to the European 
specimens. Curara is obtained for the most part from several plants 
of the Strychnos family, as Strychnos toxifera, S. cogens, and from 
Paulinia cururu. An extract from these plants, it is supposed, is 
mixed with the venom of certain poisonous reptiles, and possibly with 
other animal substances. As the arrow-poison of different tribes differs 
not only in strength, but in the character of the effects produced* by 
them, it is certain that they are derived from different sources. That 
which is now obtained in commerce as curara, and which agrees in the 
main with the description of Bernard, is the substance referred to in 
this article. 

Composition. — Curara occurs in small, irregular masses, of a dark- 
brownish color, somewhat slimy, and looking like a dried vegetable 
extract. The mass is in part soluble in water, and the undissolved 
residue is composed, for the most part, of starch-granules, vegetable 
cells, oil-drops, and other vegetable structures (Mitchell and Ham- 
mond). The existence of an alkaloid in curara had been suspected by 
Boussingault, but it was not actually discovered until 1865, when it 
was isolated by Preyer. The estimates formed of its activity vary : 
by Preyer it was held to be twenty times stronger than the crude drug, 
but by Beigel only six times ; but these differences are readily ac- 
counted for in the varying qualities and activity of curara. 

Curarine, the alkaloid, is crystallizable, deliquescent, and forms 
with acids salts, which are also crystallizable. The dose will range 
from y^q gr. to fa gr. by the stomach — from -g-J-g- gr. to -^-^ gr. when 
administered subcutaneously. A larger quantity may be necessary 
when distinct physiological effects are to be produced. 

Mitchell and Hammond give the name carrovalia to the alkaloid 
which they obtained from carroval. 

The dose of woorara or curara, the crude drug, will range from fa 
gr. to -J- gr. It is desirable to try on some inferior animal the activity 
of any new specimen before using it on man. 

Antagonists and Incompatibles. — As curara is a paralyzer, it is 
antagonized by those agents which act in the opposite manner on the 
spinal cord. From the physiological standpoint, strychnine and atro- 
pine are appropriate antagonists, opposing the tendency to death by 
failure of respiration. Remarkable results have been obtained in ani- 
mals by artificial respiration. An animal will recover from twice the 



556 MOTOR DEPRESSANTS. 

fatal quantity, if respiration be kept up until elimination occurs, which 
is speedy. As in the case of the other alkaloids, curarine is destroyed 
by the caustic alkalies. 

Synergists. — The paralyzers in general, especially the respiratory 
group, promote all of the actions of curara. 

Physiological Actions. — The taste of curara is bitter. Applied 
to the unbroken integument, it is not absorbed ; but swallowed, it slow- 
ly diffuses into the blood, and produces characteristic effects. Vul- 
pian finds that it is absorbed more rapidly when injected into muscular 
masses than when simply thrown under the skin. According to the 
observations of Yoisin and Liouville, made on man, the salivary, nasal, 
and lachrymal secretions are increased. It is probable that the gastro- 
intestinal secretions are also promoted. The rate of diffusion into the 
veins from the stomach varies, but it takes place in from twenty min- 
utes to a half -hour ; but even a longer time than this maybe required. 
The action of the heart increases ; the pulse rises a number of beats 
and may be dicrotic ; the temperature ascends two to three and a half 
degrees, and the respirations are accelerated, four to eight times per 
minute being added to the usual rate. Voisin and Liouville ventured 
on the exhibition of larger doses with the following result : the symp- 
toms began by a more or less violent chill ; the heart beat rapidly, 
reaching 140, and the pulse became weak ; the respiration was labored 
and sighing ; the temperature rose, and double vision, sometimes with 
mydriasis, sometimes with myosis, set in. The legs became weak, co- 
ordination was destroyed, and the vertical position could not be main- 
tained. The mind continued undisturbed. The paralysis disappeared 
after a short time, but a sense of fatigue persisted in the limbs for 
some hours. The increased temperature was accompanied by the 
usual symptoms of fever — there were, besides the accelerated pulse 
and respiration, headache, thirst, and perspiration. 

It was by means of curara that Bernard demonstrated the exist- 
ence of contractility as an independent endowment of muscular tissue. 
Curara, by poisoning the end-organs of the nerves in the muscles, sepa- 
rated these organs, and thus permitted a study of the agency of each. 
In all classes of animals, as in man, curara induces paralysis of move- 
ments : locomotion, the erect posture, breathing, finally the heart's ac- 
tion, are arrested. The paralysis induced by curara is not due to an 
abolition of the excitability proper to the motor nerve-trunks, but to a 
modification set up in the terminals of the intra-muscular nerves. This 
fact is proved by the well-known experiment of Bernard, repeated by 
Kolliker, Zeleuski, Yulpian, and numerous other experimentalists, in 
which a frog is paralyzed by curara in all parts of the body except 
one limb which has been ligatured to prevent the access of the poison 
to it. The muscles of the unpoisoned limb react normally to stimula- 
tion, to the will, and to reflex impressions from distant parts. The 



CURARA. 557 

muscles of the poisoned parts of the body act on direct stimulation, 
but not by the will nor by any direct or reflex excitation conveyed by 
the nerve. The paralysis must therefore be due, as above stated, to 
the effect of the poison on the terminals of the nerve in the muscular 
tissue. As movements can be induced in the muscles of the unpoi- 
soned limb by irritation of the skin at a distant point, it is clear that 
the sensory nerves and the reflex function of the spinal cord continue 
active. It has been abundantly demonstrated that in curarized ani- 
mals the spinal cord preserves its functions for a long time. If, how- 
ever, a large quantity of the poison is administered, and a fatal result 
prevented by artificial respiration, the excitability of the cord is at first 
increased but afterward paralyzed (Yon Bezold, Yulpian, etc.). The 
motor and sensory nerve-trunks are also finally affected, but this is a 
secondary action, and ascertainable in curarized animals only by main- 
taining artificial respiration a sufficient length of time. It follows, then, 
that all parts of the nervous system are ultimately paralyzed. The 
action begins in the end-organs of the motor nerves, and then grad- 
ually extends to all parts, if the dose is large enough and life is main- 
tained by artificial respiration. 

Curara also acts on the accelerator nerves of the heart, at first stim- 
ulating and afterward paralyzing them. The action of the heart is 
increased, also, by the paralyzing effect of curara on the terminals of 
the pneumogastric, thus removing the inhibition. So decidedly is the 
vagus affected by full doses of curara, that galvanic irritation does not 
arrest the movements of the heart (Von Bezold). Notwithstanding 
the increased action of the heart, the blood-pressure is lowered by cu- 
rara, due doubtless to a paralyzing action on the organic muscular fiber 
and consequent dilatation of the vessels. The effect of curara on the 
sympathetic is variously interpreted. According to Yulpian, the iris 
contracts on changes in the amount of light falling on the retina in 
curarized animals ; the pupils dilate on faradization of the skin ; dila- 
tation of the vessels of the posterior members and an elevation of tem- 
perature take place in a curarized dog on faradizing the central portion 
of the corresponding sciatic ; very energetic reflex contractions of the 
stomach, intestines, and bladder are obtained in curarized animals by 
faradizing the skin of different regions of the body (Yulpian). These 
facts indicate that curara does not destroy but rather stimulates the 
functions of the sympathetic. Curara acts on the lymph-vessels of 
frogs. According to Tarchanoff, the liquid which accumulates during 
curarization grows richer in leucocytes ; also the blood contained in 
the vessels becomes more concentrated, the relative proportion of red 
globules being increased. As the accumulation of leucocytes takes 
place in the lymph-sacs, there is a corresponding diminution of them 
in the blood. These changes are due to the paralysis of the peripheric 
vessels (Tarchanoff). 



558 MOTOR DEPRESSANTS. 

Curara, as has been stated, produces an obvious rise of temperature 
in the extremities. This is supposed to be due to paralysis of the pe- 
ripheral vessels. In the interior of the body, however, there ensues an 
equally constant decline of body-heat (Tscheschichin, Rohrig und 
Zuntz). This lowering of the central temperature is due to the loss 
of heat at the periphery by the cooling of the blood detained in the 
superficial vessels. 

Bernard long ago ascertained that curarized animals became dia- 
betic. It seems probable that this result is due to the paralysis of the 
vessels of the liver. On the other hand, Bock and Hoffmann have ap- 
parently demonstrated that the production of glycosuria is the result 
of increased activity of the liver. It may be due to the fact that the 
sugar formed does not undergo oxidation, for Jolyet has ascertained 
that in curarized animals the excretion of carbonic acid is much below 
the amount in health. By reason of the changes in the vascular sup- 
ply, curara affects the functional activity of various organs. The in- 
creased production of saliva, and of the nasal and intestinal secretions 
noted at the outset, is due, there is little doubt, to this fact. 

The elimination of curara takes place chiefly by the kidneys, but 
some escapes with the faeces (Koch). The urine of a curarized animal 
will poison another animal, and this may be repeated to several sub- 
jects. The retention of the urine charged with curara, in the bladder, 
will continue the effects of the poison by reabsorption. This state- 
ment has been the subject of considerable controversy. It has been 
denied that the mucous membrane of the bladder possesses the power 
to absorb again into the circulation poisons dissolved in the urine in 
the process of excretion. Brown-Sequard appears to have been the 
first to prove, by direct experiment, that alkaloids could be thus ab- 
sorbed, and some recent observations have confirmed the accuracy of 
his experiments. In respect to curara, as to other organic alkaloids, 
when poisoning occurs, it is an obviously proper expedient to keep the 
bladder empty, if necessary, by catheterization. 

Therapy. — The applications of curara to the treatment of disease 
follow from the results of the physiological study. Being a motor and 
not a sensory paralyzer, it is adapted to the treatment of muscular 
cramp and spasm. It is one of the remedies employed against strych- 
nine-poisoning, and although from the theoretical standpoint such 
treatment may seem proper, yet in actual practice it has not succeeded. 
That a remedy obtained from members of the strychnos family, and a 
paralyzer in action, should antagonize strychnine, is a remarkable fact. 
In the process of preparation employed by the Indians, it is in a high 
degree probable that methyl strychnium is formed, and this substance, 
as was originally shown by Crum-Brown and Eraser, is a paralyzer, 
and acts precisely like curara. Curara has been used with a limited 
measure of success in tetanus. In the successful cases — for example, 



GELSEMIUM. 559 

that narrated by Mr. Spencer Wells — large doses were administered. 
According to the statistics of Demme, of twenty-two cases of tetanus 
treated by this agent, eight recovered. Other methods have certainly 
succeeded better. Two cases of hydrophobia have been reported in 
which a cure followed the use of curara. One of these, reported by 
Dr. Watson, was examined, and the diagnosis confirmed by Dr. Flint, 
of New York. The first dose was -^ gr., and subsequently \ gr. and 
\ gr. were given. The value of this statement is impaired by the fact 
that the different specimens vary so much in activity. M. Vella has 
successfully treated a case of tetanus by cutaneous absorption of the 
agent ; but the usual mode of administration has consisted in the sub- 
cutaneous injection. This subject, as M. Vulpian has well said, has 
lost its interest since the discovery of the utility of chloral. It is in 
a high degree probable, however, that curara would be greatly more 
successful if it were pushed in these cases to obtain its full physiologi- 
cal influence, and the complete suspension of the spasms. 

By Voisin and Liouville curara has been extensively employed as 
a remedy for epilepsy. The facts already mentioned in regard to the 
action of this agent in producing febrile phenomena were obtained 
from the experiences with epileptics. They find that attacks may be 
prevented, and the condition of epileptics much improved, by the 
timely administration of this remedy. 

It has proved useful in chorea, in tie-douloureux (Beigel, Du Cazal), 
but other remedies are doubtless better. 

Authorities referred to : 

Beigel, Dr. II. Journal of Anatomy and Physiology, vol. ii, p. 329. 

Bernard, Cl. Lemons sur les Effets des Substances Toxiques et Medicamenteuses, Paris, 
1857, p. 238. 

Bock, C, u. Hoffmann, F. A. Quoted by Vulpian. 

Hammond and Mitchell. TJie American Journal of the Medical Sciences, July, 1859. 
Experimental Researches regarding Carroval and Vao. 

Kolliker, A. Virchovfs Archiv, Band x, p. 3. Physiologische Enter suchung en uber 
die Wirkung einiger Gifte. 

Riegel, Dr. Franz. Centralblatt f d. med. Wiss., 1871, p. 401. Ueber den Einjluss 
des Curare auf die Koiperlemperatur. 

Tarchanoff, M. J. Archives de Physiol. Norm, et Path., January and February, 1875. 
De V Influence du Curare sur la Formation de la Lymphe et V Emigration des Globules 
blancs du Sang. 

Voisin et Liouville. Gaz. Hebdom., Nos. 32-37, 1866. 

Vulpian, A. Ijecons sur V Action Physiol, des Substances Toxiques et Medicamenteuses, 
Paris, 1881, pp. 193-422. 

Watson, Dr. American Journal of the Medical Sciences, July, 1876. 

Zeleuski, Dr. Virchow's Archiv, Band xxiv, p. 362. Zur Frage von dcr Muskel- 
irritabilitat. 

Gelsemium. — Yellow jasmine. The rhizoma and rootlets of Gelse- 
mium sempervirens Aiton (Nat. Ord. Loganiaceee). (IT. S. P.) 



560 MOTOR DEPRESSANTS. 

Extractum Gelsemii Fluidum. — Fluid extract of gelsemium. Dose, 

m ij— m x. 

Tinctura Gelsemii. — Tincture of gelsemium. Dose, m v — m, xx. 

The so-called gelseminine is obtained by evaporation of the tinc- 
ture, and is a very uncertain preparation ; the dose is gr. ss — gr. ij. 
It is only used by the eclectic practitioners. 

Disappointment is frequently experienced from the use of gelse- 
mium preparations, owing to the fact that they are made from the 
dried root. In the process of drying, even spontaneously, the alkaloid 
disappears. The most trustworthy preparations are the official, pre- 
pared conscientiously from the fresh root. 

Composition. — Gelsemium contains a very powerful alkaloid — gel- 
semine or gelsemina — and gelsemic or gelseminic acid, by some said to 
be identical with cesculin ; but Wormley has shown the fallacy in the 
evidence on which this statement was based, and Fredigke's account 
of gelsemic acid agrees with Wormley's in all essential particulars. 
It contains also an acrid resin, volatile oil, gallic acid, a yellow color- 
ing-matter, besides some other unimportant ingredients. 

Gelsemine. — In its pure state gelsemine (gelsemia) is a colorless, 
odorless solid, having an intensely persistent, bitter taste. It has 
strongly basic properties, completely neutralizing the most powerful 
acids, forming salts of which the sulphate, nitrate, chloride, and acetate 
are freely soluble in water (Wormley). Dose, gr. -fa — gr. ^V- 

Antagonists and Incompatibles. — The caustic alkalies and tan- 
nic acid are chemically incompatible. As respects the physiological 
actions, gelsemium is antagonized by the diffusible stimulants, by 
alcohol, ammonia, opium, digitalis, etc. The lethal effects are best 
treated by emetics, warmth, alcoholic stimulants, by faradization and 
artificial respiration, by morphine subcutaneously, and, according to 
Fredigke, by the tincture of xanthoxylum fraxineum. 

Synergists. — Conium, physostigma, tobacco, opium, etc., when ad- 
ministered with gelsemium, increase its effects in the whole sphere of 
its physiological activity. 

Physiological Actions. — The preparations of gelsemium have a 
bitter and somewhat aromatic taste, and a narcotic odor. They do not 
produce gastric irritation. The active substance, being crystalloidal, 
diffuses into the blood with facility. In moderate doses, but sufficient 
to produce decided physiological effects, gelsemium causes a feeling of 
languor and mental calm, slowing of the action of the heart, drooping 
of the eyelids, dilatation of the pupil, and some feebleness of muscu- 
lar movements. In larger doses the physiological effects are as fol- 
lows : vertigo, double vision, amblyopia, paralysis of the levator pal- 
pebrae so that the upper eyelid can not be raised, dilated pupil, labored 
respiration in consequence of a paretic state of the respiratory muscles, 
slow and feeble action of the heart, great muscular weakness, and sen- 



GELSEMIILM. 561 

sibility to pain and touch much reduced. These effects are produced 
in about a half -hour after the stomach administration, and last two or 
three hours, when they subside. When lethal doses are taken, the 
above-described symptoms occur in a more intense degree. The gait 
is at first staggering, but the power of muscular movement soon ceases, 
and a sense of numbness diffuses over the body. The eyelids close 
(paralysis of the levator), the pupils dilate widely, vision is lost, and 
the pupils cease to respond to the stimulus of light. The lower jaw 
drops, and the power of speech is lost in consequence of paralysis of 
the muscles of the tongue. The respirations are labored, shallow, and 
irregular ; the action of the heart weak, feeble, and intermittent. Gen- 
erally the skin is covered with a profuse perspiration, but no other 
evacuation takes place. Death occurs from asphyxia, and the action 
of the heart ceases after the respiratory movements. Consciousness is 
preserved until near the close, and until carbonic poisoning ensues. In 
one instance (Wormley) extreme restlessness was noted, but generally 
there is a condition of calm, a soporose state, or the unconsciousness of 
carbonic-acid narcosis, and convulsions never occur. 

The author's investigations have demonstrated that gelsemium is a 
paralyzer of motility and sensibility ; that sensibility is first affected in 
cold-blooded animals (frogs), and afterward motility, and that in warm- 
blooded animals the motility is affected before sensibility. As respects 
the seat of the action, the author has ascertained that the end-organs 
of the motor nerves, and the nerve-trunks, do not lose their irritability, 
and that the muscular contractility is unimpaired. " Its paralyzing 
effect is due to its action on the motor center, and not to an action on 
the peripheral nerve-fibers. It acts also on the sensory portion of the 
cord, producing at last complete anaesthesia ; but this effect in warm- 
blooded animals, and in man, is toxic only, and follows the paralysis of 
the motor functions." Applying the precise observations which are 
made on animals to the explanation of the lethal effects which have 
occurred in man, we are conducted to the following conclusions : the 
disorders of voluntary movement, and the more or less complete pa- 
ralysis of the motor and of the sensory functions, are due to the effects 
of gelsemium on the motor and sensory portions of the cord, the func- 
tions of the sensory columns resisting longer the action of the poison. 
The labored respiration is due to the paretic state of the respiratory 
muscles, especially of the diaphragm. The depressed action of the 
heart is probably secondary to the diminished respiration movements, 
which produce this result by impeding the flow of blood through the 
pulmonary capillaries. The dilated pupil, the double vision, the ptosis, 
are due to paralysis of the third pair. 

In rabbits and cats gelsemium, in lethal doses, affects motility in a 
very remarkable manner : when the paralyzing effects are becoming 
manifest — first in the fore extremities — these animals perform a series 
36 



562 MOTOR DEPRESSANTS. 

of backward movements, in which sometimes a complete backward 
somersault occurs. In pigeons, general muscular tremors precede the 
backward movements. No corresponding acts have taken place in the 
fatal cases observed in man. A very considerable reduction of tem- 
perature occurs from lethal doses in warm-blooded animals. 

The author's experimental observations on the physiological actions 
of gelsemium have since been fully confirmed by Ott, by Ringer, and 
by O. Berger, in an elaborate series of investigations. The study of 
Ringer and Murrell is a model of a research of this kind. 

Therapy. — Gelsemium is indicated in those maladies in which an 
exaltation of function has taken place in the motor and sensory spheres 
of the nervous system. Several cases of tetanus have been reported 
cured by this remedy ; but it is impossible to say whether these were 
examples of post hoc or propter hoc. A priori it might be expected 
that gelsemium would prove serviceable in this disease, because its ac- 
tion on the spinal cord is opposed to that which takes place in tetanus. 
In strychnine-poisoning in animals, however, the tetanic spasms are not 
prevented by the administration of gelsemium. In mania, with great 
motor excitement and wakefulness, this remedy is more useful than 
conium. To bring about the best results from its administration, doses 
of sufficient strength must be given to produce definite physiological 
effects, viz., dilated pupil, drooping of the eyelids, and a feeling of 
languor. In the condition of " horrors " from alcoholic excess, in sim- 
ple wakefulness, in the insomnia which results from over-excitement 
and too great physical activity, cures are not unfrequently obtained 
by the use of gelsemium. In the inflammatory affections of the me- 
ninges, and in cerebrospinal meningitis, sporadic or epidemic, with a 
decided febrile reaction, this agent is extremely useful in small doses 
(ttI v of fluid extract), repeated every two hours so as to maintain a 
uniform physiological effect. 

Gelsemium has been used with success recently in the treatment of 
neuralgia of the fifth nerve, but the good effects of the remedy in the 
painful affections of the fifth nerve are not always manifest (Berger). 
Cases cured by this remedy were, doubtless, not instances of tic- 
douloureux, but nerve-pain caused by cold, rheumatism, or temporary 
excentric irritation. Intercostal neuralgia, sciatica, and especially my- 
algia, are frequently cured by this agent (Jurasz) ; but considerable 
doses are necessary — from five to twenty minims of the fluid extract 
every three hours until the characteristic drooping of the eyelids, dila- 
tation of the pupil, and muscular languor, manifest themselves. 

In convulsive or spasmodic cough, gelsemium often affords remark- 
able relief. It is beneficial in the spasmodic stage of whooping-cough, 
reflex cough from irritation of the laryngeal nerves, the irritative 
cough of phthisis with scanty expectoration, and the nervous cough of 
hysterical subjects. In some cases of spasmodic asthma great relief 



GELSEMIUM. 5G3 

is afforded by gelsemium, but, as is the case with all other remedies 
for asthma, it frequently fails and loses its good influence even in those 
cases in which it was at first successful. 

The author has witnessed excellent results from the use of gelse- 
mium in acute inflammations of the lungs and pleura. In pneum,onia 
it affords rest by diminishing the activity of the respiratory function ; 
it allays cough, and, by depressing the cardiac movements, it lessens 
stasis of the pulmonary capillaries and lowers the temperature. It is 
better to give medium doses {y\ iij — tt[ v of the fluid extract), every two 
hours, to maintain a constant effect within the limits of safety. It 
favors, when exhibited in this way, the occurrence of an early crisis, 
and assists in the production of one critical evacuation — the sweat. A 
similar mode of administration should be pursued in pleuritis, in which 
its use is equally rational and effective. 

Very great relief is afforded by the use of gelsemium in certain 
pelvic disorders in women. There is no more generally-useful medi- 
cine in ovarian neuralgia. The pains of dysmenorrhoea are also greatly 
alleviated by it. The evidence is conclusive that this remedy also 
suspends after-pains, and it is held by some good observers that it 
quiets the " nagging " pains of the first stage of labor. In these dis- 
orders of the female sexual organs, it is generally necessary to admin- 
ister a quantity of the remedy sufficient to produce some of its charac- 
teristic physiological effects. According to Bulkley, it is an . effective 
remedy for the relief of pruritus, and has given excellent results in the 
treatment of eczema. He prescribes from three to ten drops of the 
tincture, giving it every two or three hours until some of its charac- 
teristic effects appear. 

The first empirical use of gelsemium was in the treatment of the 
remittent or so-called bilious fevers of the South. A considerable num- 
ber of facts have been accumulated, which show that this remedy 
exercises a really beneficial influence in remittent and typo-malarial 
fevers. It is not an action of specificity — like quinine in intermittent 
and remittent fevers — and it is doubtful whether this supposed bene- 
ficial effect has any proper basis. 

Authorities referred to : 

Bartholow, Dr. Roberts. Experimental Investigations into the Actions and Uses of 
Gelsemium Sempervirens. Tlie Practitioner, London, vol. v, p. 200. 

Berger, Dr. 0. Berlin, klin. Wochenschrift, Nos. 43 and 44, 1875. 

Bulkley, Dr. L. Duncan. New York Medical Journal, May, 1881. 

Fredigke, Dr. Annuaire de TJierapeutique. Articles — Acide Gelseminique and Gel- 
semine. 

Holmes, M. JDu Gelsemium Sempervirens. Annuaire de TJierapeutique, 1877, p. 41. 

Jurasz, Dr. Centralblatt f d. med. Wissensch , No. 31, 1875. 

Ott, Dr. Isaac. On Gelsemia, pamphlet, 18G5. Also, Philadelphia Medical Times, 
vol. V. 

Porcher, Dr. Francis Peyre. Resources of the Southern Fields and Forests, p. 501. 



564 MOTOR DEPRESSANTS. 

Wormley, Dr. Theodore. A Contribution to our Knowledge of the Chemical Compo- 
sition of Gelsemium Sempervirens. Ame?'ican Journal of Pharmacy, vol. xlii, January, 
1870. 

Arnicae Flores. — Arnica-flowers. The flower-beads of Arnica mon- 
tana Linne (Nat. Ord. Compositce.) 

Arnicas Radix. — Arnica-root. The rhizoma and rootlets of Arnica 
montana. Racine d 'arnica, Fr. ; Arnicawurzel, Ger. 

Extr actum Arnicw Radicis. — Extract of arnica-root. Dose, gr. j — 
gr- iij- 

Extractum Arnicas, Radicis Fluidum. — Fluid extract of arnica-root. 
Dose, tti v — iu x. 

Tinctura Arnicae. Radicis. — Tincture of arnica-root. Dose, tti, x — 
TTj, xxx. 

Tinctura Arnicas Florum. — Tincture of arnica-flowers. Dose, tti x 
— 3 ss. 

Composition. — The chemistry of arnica has not as yet been thor- 
oughly elucidated. Walz has isolated a principle (arnicine). The 
root contains an essential oil on which depends, in great part, its physi- 
ological activity. The oil is a complex substance. One of its most 
important constituents is trimethylamine, or an analogous principle. 

Antagonists and Incompatibles. — The actions of arnica are an- 
tagonized by ammonia, alcoholic stimulants, opium, camphor, etc. 

Synergists. — Aconite, veratrum viride, digitalis, and arterial seda- 
tives generally, increase the effects of arnica. 

Physiological Actions. — Arnica excites considerable irritation of 
the skin, if the contact be sufficiently prolonged. It produces when 
swallowed a sense of heat and acridity in the fauces, and increases the 
flow of saliva. It is decidedly irritant to the stomach, and causes in 
large doses nausea and vomiting, and choleraic diarrhoea. Its active 
principles diffuse into the blood. In small medicinal doses arnica in- 
creases the action of the heart and arteries, and excites the functions 
of the skin and kidneys. In large doses, probably after a short stage 
of excitement, depression of the circulation, of the respiration, and of 
the animal temperature, ensues ; violent headache is experienced, the 
pupils are dilated, and paresis of the muscular system comes on. In 
toxic doses arnica paralyzes the nervous system of animal and organic 
life, and death ensues in a condition of collapse. 

Therapy. — In febrile diseases and inflammations, when there is 
sthenic reaction, arnica in full doses depresses the action of the heart 
and lowers the arterial tension. It is, therefore, antipyretic. For the 
production of this effect, an infusion is probably a better preparation 
than the tincture. When, however, in febrile diseases there is present 
the condition of asthenia, small doses of the tincture (five minims) are 
to be preferred. That this remedy will produce different results, in 



TRIMETHYLAMINE. 565 

small or large doses, need not occasion surprise. It is conceded on all 
sides that the effects of opium differ according to the size of the dose, 
and the frequency with which it is repeated. 

Good results have been obtained from the use of arnica infusion in 
mania and melancholia. The tincture of arnica is exceptionally ser- 
viceable in delirium tremens, with depression. 

In rheumatism and rheumatic gout, very decided curative effects 
are sometimes procured from arnica. The fact that it contains trime- 
thylamine is probably the true explanation of its utility in these affec- 
tions. It has also proved very efficacious in acute eczema, in erysipe- 
las, and other cutaneous affections of gouty and rheumatic origin. 
Dysmenorrhcea of the congestive form, acute metritis, and other acute 
pelvic inflammations, are also favorably influenced by the administra- 
tion of arnica. 

The tincture of arnica has a popular reputation for the relief of 
sprains, bruises, and external inflammations. The author has known 
violent erysipelatous inflammation to follow its application to a sprained 
ankle. It is extremely doubtful whether the good effects are more de- 
cided than those of a spirit-lotion. The infusion or decoction does not, 
it is said, cause local irritation. Planat has demonstrated that arnica 
is a remarkably effective application to boils. He directs one part of 
the extract and two parts of honey to be thoroughly incorporated, and 
the paste spread on some adhesive plaster, leaving a margin to secure 
its adhesion to the skin. The plaster is renewed every twenty-four 
hours. To increase the effect, Planat gives by the stomach the tinc- 
ture of arnica. 

Authorities referred to : 

Husemann, Dr. Theodor. Handbuch der gesarnmten Arzncimittellehre, zweiter Band, 
p. 978. 

Phillips, Dr. C. D. F. Materia Medico, and Therapeutics, p. 305. 

Planat, Dr. Proprietes de V Arnica. UAbcille Medicate, 1880. In Annuaire de The- 
rapeutique, 1880. 

Trimethylamine. — (Unofficial.) This is an ammoniacal substance, 
having a strong, fishy odor. It is isomeric with propylamine, which is 
also an ammonia. As the propylamine of commerce is a mixture of 
various substances, and is of uncertain composition, trimethylamine 
only should be used (Spencer). The dose of trimethylamine is four 
to eight minims. Its disagreeable taste may be disguised somewhat 
by peppermint- water. 

Properties. — Trimethylamine is a colorless liquid, having the 
composition C 3 H 9 N\ It dissolves freely in ether, alcohol, and water, 
has a strong alkaline reaction, and is inflammable. 

Chloride of Trimethylamine is a stable salt which crystallizes in 
long needles ; it is very deliquescent, and its solution when concen- 



566 MOTOR DEPRESSANTS. 

trated has a caustic action on the skin and mucous membrane. It is 
free from odor, except when heated or mixed with an alkali, when the 
fishy smell is evolved. The taste of a solution of this salt is alkaline, 
but not disagreeable (Dujardin-Beaumetz). Dose, grs. ij to grs. v 
every three hours. 

Antagonists and Incompatibles. — Chemically trimethylamine is 
incompatible with the mineral acids, the salts of the metals, the alkalies 
(chlorides), and vegetable infusions. It should always be prescribed 
alone, in solution in some aromatic water. Therapeutically, it is an- 
tagonized by the stimulants, opium, belladonna, digitalis, etc. 

Synergists. — All agents depressing the vascular system and the 
temperature are synergistic. 

Physiological Actions. — Applied to the skin, mucous membrane, 
or areolar tissue, trimethylamine produces decided caustic effects, com- 
parable to those which result from the action of ammonia. It excites 
gastric pain when taken into the stomach in considerable doses, and 
will, doubtless, cause a high degree of inflammation if incautiously ad- 
ministered. The most characteristic effects are the lowering of the ac- 
tion of the heart, the depression of the temperature, and the diminution 
in the amount of urea excreted. In the physiological state Dujardin- 
Beaumetz found, in some experiments on himself, that the chloride of 
trimethylamine lessened the temperature and the pulse, but these re- 
sults were much more decided when it was administered in cases of 
acute rheumatism. The influence which this agent has on the excre- 
tion of urea is still more remarkable. The observations of Dujardin- 
Beaumetz show that a gradual but considerable decline in the excre- 
tion of urea is a constant result of its administration. On the other 
hand, Spencer says that the excretion of urea is sometimes increased, 
and, in one case in which the urinary discharge was carefully studied, 
the urine was almost trebled, and the urea more than doubled by the 
use of this remedy. If the diminution of the amount of urea were a 
constant result, as claimed by Dujardin-Beaumetz, the influence which 
trimethylamine has on the body temperature might be due to an in- 
terference with the combustion process. But the facts do not as yet 
justify the construction of a theory as to its mode of action. 

Therapy. — Thus far almost the only application made of trime- 
thylamine is in the treatment of acute rheumatism and gout. In some 
cases it appears to produce almost complete relief after the administra- 
tion of a few doses, but generally a longer time is required (Awenarius, 
Dujardin-Beaumetz, Spencer, Leo). It moderates, at once, the fever 
and the joint-pain, and very decidedly shortens the duration of the dis- 
ease. It is said to diminish the tendency to cardiac complication. 

This agent, having so decided an influence on the pulse, tempera- 
ture, and excretion of urea, will in the future doubtless be applied to 
the treatment of other maladies. 



PILOCARPUS. 567 



Authorities referred to : 



Buchheim, Dr. Erwin. Ueber das Trimethylamin. Schmidt's Jahrbucher, vol. lxxxiii, 
p. 13. 

Dujardin-Beaumetz, Dr. Du Chlorhydrate de Trimethylamine dans le Traitement 
du Rhumatisme Articulaire Aigu. Bulletin General de Therapeutique, vol. lxxxiv, pp. 
337, 395. 

Leo, Dr. Berliner Minische Wochenschrift, 1875. 

Petit, M. A. Sur la Trimethylamine. Bulletin General de Therapeutique, vol. lxxxiv, 
p. 313, et seq. 

Spencer, Dr. W. II. On the Employment of Trimethylamine in Rheumatism and 
Gotd. The Practitioner, February and March, 1875. 

Pilocarpus. — Jaborandi. The leaflets of Pilocarpus pennatifolim 
Lemaire (Nat. Ord. Butacem, Xanthoxylece). (IT. S. P.) 

Infusum Pilocarpi. — Infusion of pilocarpus ( § ij — Oj). Dose, § ss 
— 1 ij. (Not official.) 

Extracium Pilocarpi Fluidum. — Fluid extract of pilocarpus. 
Dose, 3 ss — 3 ij. 

Tinctura Pilocarpi. — Tincture of pilocarpus ( 3 iv — Oj). Dose, 
3 ss — 3 ij. (Not official.) 

Composition. — The important constituent is the alkaloid — pilocar- 
pine — which possesses the physiological properties of the drug. It 
combines with acids to form salts. The salts of pilocarpine crystallize 
in the oblique system. In 1880 another alkaloid was discovered, and 
to this the name jaborine was given (Harnack und Meyer). Subse- 
quent researches fully confirmed this (P. Castaing). These alkaloids 
are closely related in composition : probably identical, but having a 
different molecular arrangement. By heat, merely by concentration 
of an acid solution, pilocarpine is converted into jaborine (Hans Mey- 
er) ; and by washing with absolute alcohol they are separated, when 
united, as is very often the case in the commercial article. As these 
two alkaloids differ very greatly in properties, it is not surprising that 
the observations made with pilocarpine at first were very discrepant. 
Chemically they differ in that the salts of jaborine do not crystallize, 
and they dissolve more easily in ether and less easily in water. Physi- 
ologically, they differ even more decidedly. Jaborine acts like atro- 
pine, to which pilocarpine is a physiological antagonist. 

Pilocarpine Hydrochloras. — Hydrochlorate of pilocarpine. Mi- 
nute, white crystals, deliquescent, odorless, having a faintly bitter taste 
and a neutral reaction. Very soluble in water and in alcohol, but al- 
most insoluble in ether or chloroform. Dose, gr. y 1 ^ — gr. ss. 

Antagonists and Incompatibles. — The caustic alkalies, the per- 
salts of iron, and the salts of the metals generally, are chemically 
incompatible. A remarkable antagonism has been shown to exist 
between pilocarpine and belladonna (Ringer and Gould). 

Synergists. — Aconite, veratrum viride, gelsemium, and remedies 



568 MOTOR DEPRESSANTS. 

which paralyze the vaso-motor nervous system, promote the activity 
of jaborandi. 

Physiological Actions. — The taste of jaborandi is rather hot and 
pungent. The considerable doses of the crude drug required to pro- 
duce physiological effects excite nausea and vomiting, especially if 
taken on an empty stomach. It has been shown, however, in recent 
experiments, that these results follow the use of the alkaloid ; hence 
it may be concluded that not bulk alone is the cause of the gas- 
tric distress, but that it is one of the physiological properties of the 
drug. 

The active principles of jaborandi diffuse readily into the blood. 
In about ten minutes after the infusion is swallowed, the face, ears, 
and neck become deeply flushed. Simultaneously perspiration begins 
on the skin, an abundant flow of saliva takes place, the nasal and bron- 
chial mucus, and the tears, are increased, and watery diarrhoea may 
occur. It is said that, when the salivary secretion is greatly increased, 
that of the skin is relatively less so, and vice versa (Fereol), but this 
is not generally admitted. The quantity of perspiration poured out 
by the skin is enormous — the sweat runs from the body and soaks the 
clothes. The quantity of saliva discharged is also very great. Ringer 
reports that in two of his cases the amount of saliva was respectively 
twenty-two ounces and twenty-seven ounces. According to Petithau, 
the sialogogue effect is constant, the diaphoretic action is somewhat 
less certain, and the diuretic effect uncertain. These conclusions are 
in accord with the general experience. 

The action of the heart is increased by jaborandi, but the arterial 
tension is notably diminished. The rise in the pulse-rate averages 
twenty beats, and the duration of this effect is about two and a half 
hours. A very distinct fall of temperature (0'5° to 2° Fahr.) ensues 
when the sweating begins, and this decline of body-heat is maintained 
on an average about four and a half hours. According to Robin, Gil- 
let de Grandmont, and others, a transient rise of temperature precedes 
the fall, but Ringer and Riegel deny the accuracy of this observation. 
In some subjects, very serious symptoms due to the sudden develop- 
ment of extensive pulmonary cedema have been observed by Thomas, 
Napier, Sanger, Jenkins, and others. 

The nauseant effects of pilocarpus and its alkaloid are, it is prob- 
able, referable to the action which it exerts on the muscular layer of 
the stomach and intestines. Very active movements of these organs 
follow its administration, and even a tetanizing action is observed. 
Secretion of the mucous membrane is increased, due, doubtless, to 
stimulation of the pancreas and the glands of the mucous membrane 
(Harnack und Meyer, Morat). 

The effects of jaborandi on children, according to Ringer, are, 
singularly enough, much less, for corresponding doses, than on adults, 



PILOCARPUS. 569 

as respects the flushing, the sweating, the salivation, and the tem- 
perature. 

More or less drowsiness, both in children and adults, follows the 
profuse sweating, and pallor succeeds to the flushing. Chilliness is 
experienced with the cessation of the sweating stage. Languor and 
debility persist for some hours after the completion of the effects. 
The drowsiness is probably not due to a direct action of the remedy 
on the cerebrum, but to the greatly-diminished vascular tonus, and to 
the loss of fluid from the vessels. Vision is generally affected. The 
pupil is usually contracted, and the power of accommodation is im- 
paired. No characteristic or constant changes in the fundus of the 
eye have been observed on ophthalmoscopic examination. Locally ap- 
plied to the eye, jaborandi causes " contraction of the pupil, tension of 
the accommodative apparatus of the eye, with approximation to the 
nearest and farthest points of vision, and amblyopic impairment of 
vision from diminished sensibility of the retina." The eye resumes its 
normal state in about an hour and a half (Tweedy). 

The results of experiment indicate that the action of jaborandi is 
paralyzant of the vaso-motor nervous system. The flushing of the 
skin is doubtless due to dilatation of the arterioles, and the increased 
action of the heart must be referred to the same cause. The sphygmo- 
graph demonstrates the lowering of the vascular tension. The decline 
in temperature must be referred chiefly to the profuse transpiration, 
but the depression of the vascular tonus may also somewhat influence 
thi3 result. The data do not yet exist for a statement of the mode in 
which jaborandi excites the salivary and cutaneous secretions. It 
probably affects the end-organs of the excito-secretory nerves (Har- 
nack und Meyer, Yulpian, Dujardin-Beaumetz, Grocco, and others). 

That pilocarpus stimulates the gravid uterus is affirmed by many 
observers. Vander Neg asserts that, when injected subcutaneously or 
into a vein, it promptly induces uterine contractions, or increases the 
energy of those already existing. Kleinwachter reports two cases in 
which it induced premature labor. Three injections of two centi- 
grammes each produced this result in one case, and two injections suf- 
ficed in the other. Dr. Prochownick, of Hamburg, also reports two 
cases of eclampsia, in which the hypodermatic injection of hydrochlorate 
of pilocarpine inaugurated labor in a half -hour. It frequently fails, 
even in considerable doses, to have this effect. Of nine reported in- 
stances in which it was used to induce premature labor, in six it was 
successful and in three it had no effect. The cases in which uterine 
action has been induced were chiefly eclampsia, and hence there is an 
important source of fallacy. 

Elimination of the active constituents of jaborandi probably takes 
place through the organs whose functions are so powerfully excited. 
It is a remarkable circumstance that the amount of urea passing out 



570 MOTOR DEPRESSANTS. 

in the sweat caused by jaborandi is enormously increased over the 
normal, amounting to from fifteen to seventeen grains. The urine is 
not increased, as a rule, but Gubler apparently demonstrated that small 
doses frequently repeated had a distinct diuretic action. His theory 
is based on the notion that, being a universal gland-stimulant, if the 
skin is not directly stimulated and the fluids directed to it, the kidneys 
will be acted on. In some instances the growth of hair has been pro- 
moted by the subcutaneous and topical application of pilocarpus (Pren- 
tiss, Andre, and others). 

The experiments which have demonstrated the existence of a physi- 
ological antagonism between jaborandi and belladonna have thrown 
much light on the action of the former. When the heart of a frog is 
arrested in the diastole by jaborandi, it immediately recommences its 
beat when atropine is subcutaneously injected (Langley). When the 
superior ganglion of the cervical sympathetic, and the lingual, and the 
pneumogastric nerve are divided, jaborandi administered causes pro- 
fuse salivary secretion ; but this action is at once antagonized and 
the secretion arrested by the injection of atropine. These agents, 
therefore, are exactly opposed as respects their action on the nerve- 
endings in the salivary glands (Carville). The effects of one grain of 
atropine, in a boy poisoned by it, were, as respects the state of the 
mouth and skin, antagonized by thirty grains of jaborandi. In three 
men the perspiration and salivation caused by sixty grains of jabo- 
randi were arrested by the subcutaneous injection of -j-J-g- of a grain of 
atropine (Ringer and Gonld). 

Comparative Action of Pilocarpine and Jaborine. — The differ- 
ences in physiological action between these alkaloids are infinitely 
greater than the chemical. There does not exist a finer illustration of 
the importance of molecular arrangement to physiological action. 
Given two alkaloids having the same ultimate constituents, their actions 
become antagonistic by reason of an unknown molecular arrangement. 
Jaborine, in its effects on the heart, lungs, pupils, and salivary glands, 
is identical with atropine. In the whole range of physiological antag- 
onisms, there is none more complete than that existing between atro- 
pine and pilocarpine. As in some specimens of pilocarpine — owing, 
doubtless, to faulty pharmaceutical processes — there is more or less 
jaborine, it is no longer difficult to explain how some observers have 
differed in their observations. As the effect of pilocarpine on the cir- 
culation and the sweat-glands is so completely antagonized by jaborine, 
it is in a high degree important, in prescribing the former, to secure a 
specimen free from the latter. 

Therapy. — Pilocarpus, acting as it does on the salivary glands, has 
been used with varying success in mumps, sometimes succeeding well, 
and then failing. According to Testa, if used in time it may arrest 
the development of the disease, and later may prevent metastasis. 



PILOCARPUS. 571 

In salivation of pregnancy, it has succeeded perfectly in a few in- 
stances, but fails often ; atropine is generally much more certain and 
effective. It is contraindicated in all affections of the gastrointes- 
tinal mucous membrane, and in weak heart due to disease of its mus- 
cular substance, or of its contained ganglia, or of the valves. It is a 
remedy of great value in cardiac dropsy, provided the contraindica- 
tions above mentioned do not exist ; its therapeutic power being 
much the same as the vapor, hot-air bath, and other means for pro- 
moting free diaphoresis. The effusions of recent pleuritis, hydro- 
thorax, and ascites, have been quickly removed by this agent. In 
asthma with profuse expectoration (humid asthma), and in bronchitis 
with abundant, non-purulent exudation, it has often been very bene- 
ficial. It must be used with caution, or not at all, in the difficult 
breathing due to dilatation of the right cavities and great venous 
trunks. According to Berkhart, pilocarpine, injected subcutaneously, 
arrests the most violent paroxysms of spasmodic asthma, and the re- 
lief persists for some time. It is equally effective, in the author's ex- 
perience, in singidtus or hiccough, but there may be incurable lesions 
underlying the spasm, when, of course, the paroxysms may be expected 
to recur again. 

Probably the most conspicuous good results from the administra- 
tion of pilocarpine have been obtained in eclampsia, from the albumi- 
nuria of pregnancy, of scarlatina, or of acute Bright's disease. The 
powerful action on the sudoriparous glands, and the excretion of the 
urinary solids by the sweat, are the causes of the extraordinary relief 
obtained from this remedy in suitable cases. It should be borne in 
mind that pilocarpus tends to excite uterine action, and hence its ad- 
ministration may, under some circumstances, be improper ; but in most 
cases this effect is desired. There are, however, two important contra- 
indications : a weak heart, from thinning and atrophy of the walls of 
the organ, or from fatty degeneration, and a tendency to pulmonary 
congestion and oedema. In some instances, in a few minutes after the 
injection, the respiration became embarrassed by congestion and oedema 
of the lungs and by enormous bronchial secretion (Sanger, Napier, G. 
Thomas). It may be well to mention that atropine, subcutaneously, 
in one case in which it was administered, removed these symptoms and 
saved the patient's life. In renal dropsy, especially scarlatinal, there 
being no contraindication in the state of the heart, it is a remedy of 
the greatest utility. 

Pilocarpine has proved to be an important addition to the re- 
sources of the ophthalmologist. In inflammatory affections with effu- 
sion and exudation it brings about resolution and absorption (Wecker). 
According to Coursserant, there is no remedy comparable to it in 
the amblyopia of alcoholism and of tobacco -abuse. It has produced 
excellent results in detachment of the retina, chronic iritis, keratitis, 



572 MOTOR DEPRESSANTS. 

haemorrhages into the vitreous, floating bodies, glaucoma, atrophic 
choroiditis, haemorrhages and exudations of the retina, commencing 
atrophy of the optic nerves, etc. (Gillet de Grandmont, Meyer, Gub- 
ler, Wecker, and others). The first-named author affirms that we 
find in pilocarpine " an absolute remedy against white atrophy." Be- 
ranger, following Gubler, proposes to use this remedy as a substitute 
for eserine in certain ocular affections requiring a myositic — an effect 
produced by pilocarpine when instilled in the eye. It has been used 
successfully de novo and as a substitute for eserine in certain paralyses 
of the ocular muscles — those consecutive to the fevers and other acute 
diseases. After the operation for cataract extraction, pilocarpine is 
used by Chalot to prevent exudations and other inflammatory changes. 
In the discussion which ensued before the Geneva Congress wheie this 
paper was read, various adverse opinions were expressed regarding the 
exhibition of this remedy in different ocular maladies. Especially was 
the danger emphasized — the danger in cases of cardiac and arterial 
diseases, and of pulmonary engorgement. 

Ringer has used jaborandi with success to increase the secretion of 
milk. As the milk-glands correspond in structure to the sudoriparous 
glands, and are merely differentiated and specialized for their particu- 
lar office, the effects of this drug in increasing the production of milk 
might have been, a priori, expected. The author has used recently a 
fluid extract of jaborandi successfully in a case of deficiency in the 
secretion of the milk of a nursing- worn an. But Dr. Max Strumpf 
denies that it has such power. 

In two cases of that very intractable disorder, diabetes insipidus, 
or polydipsia, Laycock has used jaborandi with the effect to reduce 
the quantity of urine in one case from three hundred ounces to one 
hundred and twenty ounces per diem, and, in the other, from one hun- 
dred and fifty-eight ounces to ninety-eight ounces per diem. M. Hu- 
chard reports the cure of a case of the same kind, and also one of 
glycosuria / on the other hand, Yulpian declares it to be useless. Mur- 
rell has found it to be useful in some cases of the sweats of phthisis 
and of other nocturnal sweats, but yet far inferior to atropine and 
picrotoxin. 

In scaly skin eruptions, pilocarpus has good effects by maintaining 
a moist state of the skin. It is the most efficient remedy for alopecia 
which we possess. In the treatment of this affection pilocarpine may 
be injected subcutaneously, or the fluid extract can be applied locally. 
The following is a very successful topical application : I> Ext. pilo- 
carpi fl., f j ; tinct. cantharidis, 3 ss ; lin. saponis, § ijss. M. Sig. : The 
scalp must be well rubbed with this lotion daily. In prurigo Pick 
had success, but failed in psoriasis, and he also succeeded in two 
cases of pruritus senilis and in one of urticaria. In alopecia pity- 
rodes, he had good results in ten cases, but not in alopecia areata. 



PHYSOSTIGMA. 573 

Pick administered one sixth of a grain three times a day by the 
stomach. 

Recently Guttmann has brought forward pilocarpine as a remedy 
for diphtheria. He reports having successfully treated eighty-one 
cases without a single death, but these extraordinary results have not 
been confirmed. Numerous observations have been published, but out 
of the mass of cases and reports we can select only some of the most 
important. Soon after Guttmann's paper appeared, confirmatory state- 
ments were published by Lax, and directly contradictory by Lashke- 
witz. The latter lost all his cases treated with pilocarpine. Pitschen 
and Dilewsky, on the other hand, succeeded in curing many which 
would otherwise, they think, have died. Archambault treated twenty- 
one cases according to Guttmann's plan, and of these twelve died, a 
result which he considers bad. In this country Jacobi was one of the 
first to make a trial of the new remedy, and he pronounced against its 
utility. Payraudeau, who has made an exhaustive study of the sub- 
ject, offers some conclusions which seem to the author eminently sound. 
The false membrane in inaccessible situations is softened and detached 
by the action of pilocarpine ; it does not effect the elimination of the 
diphtheritic poison by the sweat which it induces ; it is apt to cause 
nausea, vomiting, and diarrhoea, and may in this way greatly increase 
the danger of the case ; it is positively contraindicated when the car- 
diac muscle is weakened in any way. Although these positions are 
perfectly tenable, there are facts more favorable to the utility of pilo- 
carpine. They are well stated by Courtois : The results of the treat- 
ment of diphtheria by pilocarpine, without being so good as were at 
first supposed, are nevertheless worthy of careful consideration. Chil- 
dren of less than five years offer such slight resistance to the action 
of the morbific germs of diphtheria, that they are rarely cured. Those 
above this age, in which the mixed form of the disease is most fre- 
quent, are especially favorable subjects for this treatment. The false 
membrane is more thoroughly detached, and has less tendency to be 
reproduced, than by any other treatment. All are now agreed that 
efficient support must be given the patient by food and alcohol during 
the pilocarpine treatment ; that cases characterized by extreme depres- 
sion of the vital powers, and by weakness of the heart, are unsuited 
for this remedy. 

Guttmann exhibited pilocarpine with hydrochloric acid and pepsin 
by the stomach, giving from -fa gr. to \ gr. Archambault adminis- 
tered the remedy by the stomach generally, but, in urgent cases, hypo- 
dermatically. Chiotti preferred rectal injections of a simple solution. 

Physostigma. — Calabar bean. The seed of Physostigma veneno- 
sum Balfour (Nat. Ord. Leguminosce, Papilionaceaz). (U. S. P.) Fhve 
de Calabar, Fr. ; Kalabarbohne, Ger. 



574 MOTOR DEPRESSANTS. 

Extractum Physostigmatis. — Extract of physostigma. Dose, gr. -j- 
— gr. ss— gr. j. 

Tinctura Physostigmatis. — Tincture of physostigma. Dose, v\ v — 
ill xx. 

Composition. — Calabar bean contains two alkaloids, physostigmine 
and eserine. These have been supposed to be the same, but they differ 
in important particulars. Physostigmine has an alkaline reaction, is 
amorphous, colorless, and tasteless. Eserine crystallizes in colorless, 
rhomboidal plates, and has a bitter taste. Eserine has strong basic 
properties, and combines with acids to form salts, which are freely 
soluble. But they seem to agree perfectly in physiological action. 
The Calabar bean contains, besides these alkaloids, the ordinary con- 
stituents of the common bean, viz., albuminous matters, starch, and oil. 

PhysostigmincB Salicylas. — Salicylate of physostigmine. In col- 
orless, shining, acicular, or short columnar crystals, turning reddish 
on long exposure to light and air, odorless, having a bitter taste and 
a neutral reaction. Soluble in 130 parts of water, and in 12 parts of 
alcohol at 59° Fahr. Dose, gr. -j-J-g — gr. -fa. 

Antagonists and Incompatibles. — The vegetable astringents, 
tannic acid, and the caustic alkalies, are chemically incompatible. As 
respects physiological actions, physostigma is antagonized in a limited 
part, but not in the whole of its actions, by atropine, and still more by 
chloral. Therapeutically, the tetanizing agents may be regarded as 
opposed to physostigma. 

Synergists. — The paralyzers, or depressors of the motor nervous 
system, conium, gelsemium, nitrate of amyl, etc., act in harmony with 
physostigma, increasing its effects in the whole range of its physiologi- 
cal influence. 

Physiological Actions. — The preparations of physostigma are apt 
to excite nausea. Increased secretion of the gastro-intestinal mucous 
membrane, and increased peristalsis, follow their administration. The 
active principles quickly diffuse into the blood. Physostigma does not 
impair the respiratory function of the blood, but, after death, loose 
coagula are found, the globules have undergone changes of shape, and 
rectangular plates of hsemato-crystallin occur (Leven and Laborde). 
The action of the heart is affected by considerable toxic doses ; it is 
paralyzed in the diastole, and is flabby, but it contracts lazily on elec- 
tric stimulation. In less than lethal doses the action of the heart is 
slowed, and the arterial tension is, for a brief period, lowered, but soon 
rises considerably above the normal. As these -effects are not due to 
an action on the inhibitory apparatus, and follow when the heart is 
separated from the vaso-motor center by division of the spinal cord, it 
is probable that the action consists in a stimulation of the cardiac gan- 
glia, and a subsequent paralyzing action on the cardiac muscles. The 
same result may be due to a paralyzing action on the accelerator nerves 



PHYSOSTIGMA. 575 

of the heart (Kohler). The respiration is more powerfully affected 
than the circulation. When a lethal dose is administered the respira- 
tion becomes slower and shallower, and death ensues from arrest of 
the respiratory movements (asphyxia), the heart continuing in action 
for some time afterward. 

Physostigma does not affect the centers of conscious impressions, 
and consciousness is preserved until the oxygenation of the blood is so 
far interfered with that carbonic-acid narcosis supervenes. Giddiness, 
vertigo, and a sense of muscular weakness and fatigue, are produced 
by considerable doses (Gubler). When a lethal dose is administered 
to an animal, its muscular system soon grows weak, and complete pa- 
ralysis soon after ensues. The voluntary muscular system, however, 
before complete resolution occurs, is agitated by a succession of tremors 
— temporary tetanic contractions followed by entire relaxation. These 
muscular tremblings occur, but more feebly, after complete paralysis, 
and persist in a slight degree after death. The muscular contractility 
is not destroyed, not even impaired, by physostigma. 

The irritability of the motor nerves is affected, if at all, to a very 
slight extent, and the sensibility of the sensory nerves is rather height- 
ened. It follows from these facts that the paralyzing effect of phy- 
sostigma is due to a direct action on the spinal cord. 

Attention has not thus far been directed to the influence of physo- 
stigma on the pupil. Whether introduced directly into the eye, or 
taken into the stomach, or thrown under the skin, it contracts the pupil. 
This is a local and peripheral action, exactly corresponding, as to its 
seat, to the action of atropine. The end-organs of the sympathetic, or 
of the motor oculi, and it may be of both, are acted upon. By some 
it is held that the contraction of the pupil is due to a tetanic state of 
the circular fibers (Grtinhagen, Rogow) ; by others, to a paralysis of 
the dilator system (Fraser, Hirschmann). It were probably safer to 
accept the conclusion that the nerves innervating both sets of fibers 
are acted on — the motor oculi stimulated (see case by T. Wharton 
Jones, " Practitioner," vol. iii), the sympathetic depressed — for we 
find that tetanic contraction of the muscular fiber of the intestine, 
followed by dilatation and a paretic state, can be experimentally 
produced by physostigma. The apparatus of accommodation is also 
affected ; myosis begins in ten to fifteen minutes after eserine is in- 
serted. Direct galvanization of the iris, contracted by physostigma, 
causes it to dilate (Engelhardt, Hermann). 

Thekapy. — The applications of physostigma to the treatment of 
disease are by no means so important as the elaborate study given to 
its physiological action, by various observers, would seem to indicate. 

In torpor of the muscular layer of the intestine, combined with 
deficient secretion of the mucous membrane, this agent is often very 
serviceable. In some subjects fifteen minims of the tincture, or a half- 



576 MOTOR DEPRESSANTS. 

grain of the extract, taken at bedtime, will procure a morning evacua- 
tion, but it frequently fails. When the state to be relieved is such as 
is indicated above, a combination of physostigma, belladonna, and nux- 
vomica, is sometimes very effective : t> Tinct. physostigmatis, tinct. 
nucis vomicae, tinct. belladonnae, aa 3 ij. M. Sig. : Thirty drops in 
water, morning and evening, r^ Extract, physostigmatis, ext. bella- 
donnae, ext. nucis vomicae, aa gr. v. M. Ft. pil. no. x. Sig. : One pill 
at bed-hour. Physostigma (gr. \ — gr. ss of the extract) is a useful ad- 
dition to a cathartic pill. r> Ext. physostigmatis, resin ae podophylli, 
aa grs. iij. M. Ft. pil. no. vj. Sig. : One pill at bed-hour. 

To the troublesome flatulence of women at the climacteric period, 
usually associated with a paretic state of the muscular layer of the 
bowel, very great relief is often afforded by the use of physostigma. 
With the relief to the flatulence there usually follows relief to the 
morbid fancies, the headache and vertigo connected with it. 

The action of physostigma on the spinal cord, as a paralyzer, natu- 
rally suggested its use in tetanus. The evidence of its utility is dis- 
crepant. Moreover, tetanus, in many instances, manifests a tendency 
to spontaneous cure. It is difficult, therefore, to estimate the precise 
value of physostigma, but about one half of the cases treated with this 
agent recover — according to Watson, ten in eighteen ; according to 
Roemer, twenty in forty-seven cases. A larger measure of success 
might have been achieved, had sufficient attention been paid to the 
quality of the extract used and to the mode of administration. The 
following remarks by Dr. Fraser, in regard to the treatment of tetanus 
by Calabar bean, are of great importance : 

" I should myself feel inclined always to commence the treatment 
by subcutaneous injection, and to repeat such injection until the sys- 
tem is decidedly affected, and then to administer the remedy by the 
mouth in a dose three times as large as is found necessary by subcu- 
taneous injection. Such a plan might be quite safely followed in a 
child of even nine years. If the remedial effects continue to be pro- 
duced by administration by the mouth, it should be persevered with, 
for such administration has obvious advantages as far as the conven- 
ience of the practitioner is concerned. In the more severe cases, how- 
ever, I believe subcutaneous injection should be alone employed. 
The distress and increase of spasm caused by swallowing, or the im- 
possibility of introducing substances by the mouth, will render this 
necessary. I can not, also, too strongly urge that subcutaneous injec- 
tion should always be used when severe and continued spasms occur, 
when a fatal result is imminent from the exhaustion caused by pro- 
longed and frequent convulsions, and when apnoea threatens at once 
to close the tragic scene. By it we obtain the quickest and most pow- 
erful effect. 

"From the preceding remarks it can not be expected that any 



PHYSOSTIGMA. 577 

arbitrary rules of dosage can be laid down. For an adult one grain 
of the extract by the stomach, or one third of a grain by subcutane- 
ous injection, will generally be sufficient to commence with. This 
should be repeated in two hours, when its effects will usually have 
passed off, and the succeeding doses may be modified according to the 
experience that will be thus gained. . . . The great object is to pro- 
duce as quickly as possible, and then to maintain, the physiological 
effect of physostigma in diminishing reflex excitability. The doses 
must, therefore, be continued in increasing quantities until this physi- 
ological effect is produced, or until the sedative action of the drug on 
the circulation is carried to a dangerous extreme, or until constant 
nausea and vomiting compel us to desist." 

Influenced by theoretical considerations, physostigma has been 
prescribed in chorea and epilepsy, but the results have not been en- 
couraging. It is true, successful cases of chorea have been reported, 
but the influence of favorable hygienic surroundings and time is so 
great in uncomplicated chorea, that we may well doubt whether phy- 
sostigma has any real influence. Of twelve cases of epilepsy treated 
by this agent, six were improved, and in the other six a notable in- 
crease in the number of the epileptic paroxysms took place (Williams). 

In progressive paralysis of the insane, remarkable improvement 
has occurred under the use of physostigma in a few cases (Browne), 
but in others the results have been entirely negative (Williams). As 
in this melancholy disorder no remedies have hitherto been of any 
avail, it is a gratifying fact that in some cases Calabar bean has 
seemed to stay its progress. 

Since it has been shown that physostigma lessens the activity of 
the respiratory function, lowers the action of the heart, and depresses 
the temperature, it has been used in bronchitis, congestion of the lungs, 
and pneumonia, with a degree of success which warrants more ex- 
tended and systematic use. 

Besides the various applications in ophthalmic practice growing 
out of the myosis produced by physostigma, it has been used with 
success in certain paralytic and convulsive states of the ocular muscles. 
In a case of paralysis of the third nerve, with ptosis, double vision, 
and immobile pupil, Wharton Jones effected a cure by the instillation 
of physostigma into the eye, whence he concludes that the myosis 
caused by this agent is due to the stimulation of the third nerve. 
Galezowski recommends the instillation of physostigma into the eye 
in cases of suppuration of the cornea and in amblyopia. Eserine disks 
(of gelatin) have been successfully employed in tic. 

The experiments — thirty in number — of the British Medical Asso- 
ciation Committee, with regard to the antagonism between physo- 
stigma and strychnine, have led them to the following conclusion : 

" Although the symptoms produced by either substance were mod- 
37 



578 MOTOR DEPRESSANTS. 

ified considerably by the action of the other, there was no instance 
of recovery from a fatal dose." 

The antagonism between atropine and physostigma, at least to a 
considerable extent, has been well established, especially by the labors 
of Fraser. In 1864 Klein wachter, influenced probably by the marked 
antagonism of the two agents on the pupil, employed physostigma 
with success in a case of poisoning by atropine. The British Asso- 
ciation Committee, however, conclude as the result of their investiga- 
tions that — "1. Sulphate of atropine antagonizes to a slight extent 
the fatal action of extract of Calabar bean ; 2. The area of antago- 
nism is more limited than even Dr. Eraser has indicated in his paper 
on the subject. 

"Thirty-one experiments, performed by the committee with hy- 
drate of chloral and Calabar bean, have shown that — 

" 1. Hydrate of chloral modifies to a great extent the action of a 
fatal dose of extract of Calabar bean, mitigating symptoms and pro- 
longing life. 

" 2. Hydrate of chloral, in some cases, saves life from a fatal dose 
of Calabar bean. 

" 3. If hydrate of chloral be given before extract of Calabar bean, 
so that the animal is deeply under the influence of hydrate of chloral 
before it receives the extract of Calabar bean, the symptoms pro- 
duced by the latter are much modified, and life is saved from the ef- 
fects of what would otherwise be a fatal dose. 

" 4. Chloral hydrate is of little service as an antagonist to extract 
of Calabar bean, if given some time after the latter. If the symptoms 
of the action of Calabar bean be in full operation, it will not save life, 
however it may modify symptoms." 

Uses of Eserine. — This alkaloid represents the powers of the plant, 
and is the most eligible form for internal administration, and for local 
use in ophthalmic therapeutics. Merck, however, maintains that the 
salicylate of physostigmine is the best preparation of the alkaloids, 
and it has been made official. The dose for internal and hypodermatic 
use ranges from -^ to -fa of a grain. Gelatin disks of eserine are now 
most frequently employed for instillation into the eye, but a neu- 
tral solution of any of its salts is convenient for this purpose. It is 
now largely used to counteract the effects of atropine on the pupil ; in 
iritis, to break away or prevent the formation of adhesions ; in ulcer- 
ation and suppuration of the cornea ; after extraction of cataract, to 
prevent suppuration (Wecker) ; in the operation of iridectomy. The 
curative influence of eserine in these cases is due to its action in low- 
ering the intra-ocular tension, in diminishing the conjunctival secre- 
tions by contracting the blood-vessels, and in checking the migration 
of the white blood-corpuscles (Wecker). Eserine may be substituted 
for physostigma for all purposes, by the stomach or hypodermatically. 



TOBACCO. 579 

Authorities referred to : 
Arnstein tjnd Sustchinskt. Schmidt's Jahrbiicher der gesammten Medicin, Band 

cxlii, p. 286. 

Bennett Dr. J. Hughes. Report of the Committee of the British Medical Association 
to investiaate the Antagonism of Medicines. British Medical Journal, January 23, 1875. 

Browne Dr. J. Crichton. British Medical Journal, p. 60, January 10, 1874. 

Fraser Dr. Thomas R. An Experimental Research on the Antagonism between the 
Actions of Physostigma and Atropia, Edinburgh, 1872. (I am indebted to the courtesy of 
Dr. Fraser for a copy of this important memoir.) 

Galezowski, Dr. Xavibr. Gazette des Hopitaux, 124, 1869. 

Grunhagen, Dr. Virchow's Archiv, Band xxx, p. 521. 

Hermann, Prop. Dr. L. Lehrbuch der experimentellen Toxicologic, Berlin, 1874, p. 337. 

Jones, T. Wharton. Tlie Practitioner, vol. iii, and vol. vii, p. 345. 

Kohler, Dr. H. Experimentelle Beitrage zur Kenntniss der Herzwirkung des Calabar, 
etc. Archiv fur experimentelle Pathologie und Pharmacologic, 1873, p. 276. 

Laschkewich, Dr. Virchow's Archiv, vol. xxxv, p. 294. 

Laborde et Levkn, MM. Gazette de Paris, 3, 6, 1870. 

Papi, Clementi. (Gaz. Lomb.) Schmidt's Jahrbiicher, vol. cxlii, p. 286. 

Roemer, Dr. B. St. Louis Medical Journal, 1873, p. 367. 

Subbotin, Dr. Victor. Ext. sem. Physostigmatis venen. bei atonischem Zustande des 
Darmkanals. Archiv fur Min. Medicin,\i, 2, 3, p. 285, 1869. 

Watson, Dr. Eben. The Practitioner, vol. iii, p. 146, and Edinburgh Medical Jour- 
nal, May, 1867, p. 999. 

Tabacum. — Tobacco. Tabac, Fr. ; Tabakblatter, Ger. The com- 
mercial dried leaves of Nicotiana tabacum Linne (Nat. Ord. Solana- 
cece). (IT. S. P.) 

Infusum Tabaci. — Infusion of tobacco ( 3 j — Oj). Dose, as an 
enema, § ss — § iv. (Not official.) 

Oleum Tabaci. — Oil of tobacco. (Not official.) 

Unguentum Tabaci. — Tobacco-ointment ( § ss — f viij). (Not offi- 
cial.) 

Vinum Tabaci. — Wine of tobacco ( § j — Oj). Dose, -nj, v — 3 ss. 
(Not official.) 

Composition. — Tobacco contains a powerful alkaloid — nicotine — 
in combination with malic acid. It is an oily, colorless liquid, strongly- 
alkaline in reaction. Its taste is hot and acrid, and its odor disagree- 
able and peculiar. It is contained in the dried leaves, in the propor- 
tion of about five per cent. 

Tobacco also contains a peculiar camphor — nicotianine. 

Tobacco-leaves are rich in mineral constituents — potash, lime, ni- 
trates, and phosphates. The vapor of tobacco "contains numerous 
basic substances of the picolinic series, and cedes to caustic potash, 
hydrocyanic acid, sulphureted hydrogen, several volatile fatty acids, 
phenol, and creosote" (Fltickiger and Hanbury, Husemann). It does 
not contain nicotine. The oil of tobacco is an empyreumatic product, 
obtained by distillation. 

Antagonists and Incompatibles. — The caustic alkalies, tannin, 



580 MOTOR DEPRESSANTS. 

and the iodides, are chemically incompatible. Strychnine is, accord- 
ing to Haughton, a true physiological antagonist. Ergot, digitalis, 
belladonna, ammonia, and alcoholic stimulants, antagonize the effects 
of tobacco on the heart and arterial system. 

In cases of poisoning, the stomach should be evacuated by emetics 
or the stomach-pump, and tannin and the iodides should be adminis- 
tered. Ammonia and brandy are indicated to relieve the failing cir- 
culation. Subcutaneous injection of strychnine should also be resorted 
to, and, if necessary, artificial respiration. 

Synergists. — All of the motor depressants increase the effects of 
tobacco. 

Physiological Effects. — Tobacco is a severe and very depress- 
ing nauseant and emetic. It is locally an irritant to the mucous mem- 
brane, and produces burning pain at the epigastrium. It is also laxa- 
tive even when smoked, and in considerable quantity by the stomach 
causes hypercatharsis. The emetic effect of tobacco is, doubtless, the 
product of three factors : its cerebral action, its local irritation of the 
gastric mucous membrane, and its specific emetic property. The secre- 
tions of the intestinal mucous membrane are increased, and the mus- 
cular layer is thrown into tetanic contraction, whence the catharsis 
which follows its administration. Applied to a wounded surface, 
tobacco produces the same effects. 

Its active principle, nicotine, a crystalloidal substance, diffuses into 
the blood with great rapidity. It corresponds, in the mode and inten- 
sity of its action, to prussic acid. In a case narrated by Taylor, a fatal 
result ensued in three minutes after a toxic dose. In another case, 
death occurred in five minutes (M. Fougnies, poisoned by Count Bo- 
carme). When a lethal dose is administered to an animal, the action 
of the heart continues after respiration has ceased. Its cavities are 
usually found empty, or containing black fluid blood. Tobacco is not, 
therefore, a cardiac poison, and the depression of the circulation noted 
when full medicinal doses are administered is, doubtless, due to the 
interference with the pulmonary functions. Applied directly to the 
muscular tissue of the heart, nicotine does not impair its contractile 
power (Benham). The blood throughout the body is black and fluid ; 
but, as agitation with oxygen restores its color, and as the blood- 
globules are unaffected, the condition of the blood is doubtless due to 
the arrest of oxygenation (asphyxia). 

Trembling and clonic spasms are produced by lethal doses of to- 
bacco. Its ultimate effect is paralyzing, but preceding the muscular 
relaxation and paresis there is in animals, and occasionally in man, a 
definite tetanic stage. Death ensues through its paralyzing action on 
the muscles of respiration. The end-organs of the motor nerves lose 
their excitability, next the trunks of the nerves, and then the spinal 
cord, but the muscular irritability is unaffected. The brain is not 



TOBACCO. 581 

directly affected. Giddiness and delirium have been noted in cases of 
poisoning by tobacco, but these symptoms, as well as the insensibility 
which immediately precedes death, are no doubt due to the accumu- 
lation of carbonic acid in the blood. The pupils are contracted by 
tobacco, and, in fatal cases, are insensible to light. 

There is considerable sweating, and the skin is cold and clammy in 
fatal cases. The temperature of the body is decidedly reduced (Tsches- 
chichin). The elimination of nicotine probably takes place by the kid- 
neys. Yery free urinary discharge, at all events, is produced by to- 
bacco, and, reasoning by analogy, it may be supposed that this effect 
is due to the direct action of the nicotine on the Malpighian tufts and 
on the tubules of the kidneys. 

When a lethal dose of nicotine has been taken, and the effects fol- 
low immediately, there may be none of the symptoms described above. 
In the case narrated by Taylor, the " deceased stared wildly ; there 
were no convulsions, and he died quietly [in three minutes], heaving a 
deep sigh in expiring." 

Therapy. — In habitual constipation, due to a relaxed state of the 
muscular layer of the bowel, five minims of the wine of tobacco, ad- 
ministered at bedtime, will not unfrequently afford relief. 

Impaction of the coscum, colica pictonum, sometimes intussuscep- 
tion, and strangulated hernia, may be overcome by a tobacco-enema. 
It must be borne in mind, however, that this is an expedient not free 
from danger. Numerous deaths have been caused by it, and Dr. Cope- 
land reports one instance in which thirty grains by enema proved fatal. 
Of the official infusion ( 3 ]* — Oj) it is not safe to use more than four 
ounces, or fifteen grains ; and this quantity may be expected to pro- 
duce most depressing nausea. It must be urged in favor of this remedy 
that it has, in very unfavorable cases, proved exceedingly effective. 
It is especially adapted to cases in which obstruction has occurred 
from paresis of the muscular layer of the bowel (impacted caecum, 
typhlitis, painter's colic). 

Tobacco is one of the antispasmodic remedies used in the treatment 
of spasmodic asthma, and the paroxysms of difficult breathing in em- 
physema. It enters as a constituent in various pastilles and cigarettes 
employed in these maladies. Asthmatics, unaccustomed to the use of 
tobacco, are sometimes relieved by smoking a cigar or pipe, but the 
effect is lost by habitual use. Laryngismus stridulus may be quickly 
arrested by a snuff -plaster to the neck — an effective but dangerous 
domestic remedy. Obstinate hiccough, or singultus, may be cured by 
five-minim doses of wine of tobacco, but we possess other useful reme- 
dies, less dangerous and less unpleasant in action. 

We possess no remedy more effective in the treatment of tetanus 
than tobacco. It may be used in the form of an enema, commencing 
with four ounces of the infusion, and regulating the quantity to be 



582 MOTOR DEPRESSANTS. 

administered and the time of administration by the effect produced. 
Minim-doses of the alkaloid may be given every two hours by the 
stomach, or two minims by the rectum (Haughton). When it acts 
favorably, it relaxes the trismus so that nutriment may be taken, and 
suspends the tonic convulsions. Care must be used not to introduce 
a lethal quantity, and produce death by asphyxia. The author has 
known the wine of tobacco to be used successfully in a severe case of 
tetanus, the quantity administered being regulated by the effect of the 
remedy on the convulsions. 

The experiments of Haughton having demonstrated an antagonism 
between nicotine and strychnine, he proposed the use of nicotine in 
stryclmine-poisoning, and cases have occurred in which it proved en- 
tirely successful. As the effects of nicotine are so nearly instantane- 
ous, the stomach administration — if the spasms do not prevent — will 
suffice, but rectal and even hypodermatic injections may be resorted 
to if necessary. The following formula of Erlenmeyer may be used 
for the subcutaneous injection in strychnine-poisoning and in tetanus : 
^ Nicotinse, gr. ss ; aquae destil., 3 ij. M. Sig.: Ten minims contain 
yz of a grain. The cases of strychnine-poisoning in which tobacco 
was used successfully were treated by the infusion. 

Tobacco was formerly employed in the treatment of dropsy. It is 
adapted to those cases in which digitalis is now used. It promotes free 
diuresis, and is at the same time laxative — effects especially serviceable 
in cardiac dropsy. It is, however, so disagreeable in action that few 
practitioners have the temerity to prescribe it, and few patients are 
willing to swallow it. 

There is no doubt that excessive use of tobacco lessens the venereal 
appetite. Slightly nauseating doses of the wine of tobacco will check 
chordee and priapism. Satyriasis is effectively quenched in tobacco- 
nausea. Nocturnal pollutions, due to repletion and to continence, are 
also usually suspended by the use of this remedy ; but it is, unfor- 
tunately, so horribly depressing that the remedy may be justly con- 
sidered the greater evil. 

Local Uses of Tobacco. — So many unfortunate accidents have re- 
sulted from the external application of tobacco, that its use in this 
way is rarely justifiable. The infusion and an ointment have been 
employed with success in tinea, scabies, prurigo, pityriasis, etc. An 
injection of tobacco will destroy ascarides, but it is unsafe. Other 
and more manageable remedies have entirely taken the place of tobacco 
in the local diseases above named. 

Authorities referred to : 

Benham, Dr. W. T. On the Action of Nicotine. West Riding Lunatic Asylum Re- 
ports, vol. iv, p. 307. 

Blatin, M. le Dr. Recherches Phys. et Clin, sur la Nicotine et la Tabac. Gaz. des 
Hopitaux, 1870, p. 221. 



LOBELIA. 583 

Copland, Dr. Dictionary of Practical Medicine, article Colic, vol. i, p. 443. 

Curling, Mr. T. B. A Treatise on Tetanus, London, 1836. 

Erlenmeyer, Dr. A. Die subcutanen Injectionen der Arzneimittel, 3. Auflage, p. 85. 

Fluckiger and Hanbury. Pharmacographia, English edition, p. 418. 

Haughton, Rev. Prof. Dublin Hospital Gazette, December, 1856, and Dublin Quar- 
terly Journal, August, 1862, p. 172. 

Hermann, Dr. L. Handbuch der cxper. Toxicologic, p. 318. 

Husemann, Dr. Theodor. Handbuch der gesammten Arzneimittellehre, zweiter Band, 
p. 1142. 

Hirschmann, Dr. Abstract in Bull. Gen. de Therap., lxv, p. 561. 

Hirt, Dr. Ludwig. Die Krankheiten der Arbeiter, erster Theil, p. 156, et seq. 

Nasse, Dr. 0. Centralblatt fur die med. Wissensch., 1865, p. 785. 

Tardieu, A. Diet, d? Hygiene, deuxieme edition, 1862, article Tabac, p. 229, et seq. 

Taylor, Dr. A. S. On Poisons, third English edition, p. 803. 

Tscheschichin. Arch, fur Anatomie und Physiologie, 1866, p. 151. 

Traube, Dr. L. As quoted by Hermann. 

Uspensky, P. Arch, fur Anat. und Physiologie, 1868, p. 522. 

Yan Praag, Dr. L. Arch fur Anat. und Physiologie, viii, p. 56. 

Von Basch und Oser. Wiener medicinische Jahrbiicher, 1872, p. 387. 

Lobelia. — lobelia. The leaves and tops of Lobelia inflata Linne 
(Nat. Ord. Lobeliacece), collected after a portion of the capsules have 
become inflated. (TJ. S. P.) Indian tobacco. Lobelie enfl'ee, Fr. ; 
Lobeliakraut, Ger. 

Acetum Lobelim. — Yinegar of lobelia. (Lobelia, ten parts — diluted 
acetic acid to make one hundred parts.) Dose, ttj, v — 3 j. 

Tinctura Lobelim. — Tincture of lobelia. (Lobelia, twenty parts — 
diluted alcohol sufficient to make one hundred parts.) Dose, tt[ v — 3 j. 

JEJxtractum Lobelice Fluidum. — Fluid extract of lobelia. Dose, 
m j— 3 ss. 

Composition. — The effects of lobelia are due to the presence in it 
of a peculiar alkaloid — lobeline. This principle is oily in consistence, 
has a pungent, rather acrid taste, a tobacco-like odor, and is strongly 
alkaline in reaction. It is slightly soluble in water, but more freely 
soluble in alcohol and ether. It combines with acids to form crystal- 
lizable salts, which are soluble in water and in alcohol. The active 
principle — lobeline — is combined in the plant with lobelie acid. 

Antagonists and Incompatibles. — The caustic alkalies decom- 
pose lobeline ; hence these are incompatible. The depressing effects 
of lobelia on the circulation are counteracted by digitalis, belladonna, 
ergot, and other vaso-motor excitants, by alcohol, ether, ammonia, 
etc. ; on the nervous system of animal life, by strychnine, picrotoxin, 
thebaine, etc. 

Synergists. — All of the motor depressants increase the effects of 
lobelia. 

Physiological Actions. — The taste of lobelia is pungent and acrid, 
and it persists for a long time in the fauces. The leaves chewed excite 
a very abundant flow of saliva, and soon cause a feeling of epigastric 



584 MOTOR DEPRESSANTS. 

depression and nausea, with giddiness and headache. The preparations 
of lobelia administered by the stomach produce, in considerable doses, 
a degree of nausea and depression which amounts to anguish. An 
abundant outpouring of gastric mucus takes place, and vomiting en- 
sues, with great straining and distress. The action of the heart is 
enfeebled ; headache and vertigo are experienced ; a profuse sweat 
breaks out on the surface of the body ; the intestinal canal is relaxed, 
and the discharge of urine is increased. «> When a lethal dose is taken, 
especially if vomiting do not occur, the effects are chiefly expended on 
the nervous system of animal life. Muscular weakness and trembling, 
shallow respiration, coldness of the surface, feeble circulation, insensi- 
bility, and sometimes convulsions, have occurred. Death ensues from 
paralysis of the muscles of respiration — the action of the heart contin- 
uing after respiration has ceased. The insensibility is doubtless pro- 
duced in the same way as by tobacco, and the cerebral effects are not 
the result of a direct action of the poison. 

According to the investigations of Ott, lobeline, in moderate doses, 
first " increases the blood-pressure by acting as an excitant on the 
peripheral vaso-motor nervous system." This primary effect is not of 
long duration, a fall in the blood-pressure soon occurs, the peripheral 
circulation is so embarrassed from weakened power of the heart, and 
obstructed pulmonary circulation, that oxygenation of the tissues is 
rapidly impaired, and a marked reduction of temperature takes place. 
Lobeline affects chiefly the motor nervous system, and especially the 
medulla oblongata and its respiratory center (nucleus of pneumo- 
gastric). 

Therapy. — Lobelia is much employed by the self-styled physio- 
medical practitioners as a " sanative agent." The great quantity of 
mucus discharged from the stomach under its emetic action is consid- 
ered by them a proof of its power as an eliminating agent. As an 
emetic, lobelia is entirely too harsh and depressant to justify its use 
for this purpose. In habitual constipation, dependent on atony of the 
muscular layer of the bowel and deficient secretion of the mucous 
membrane, good results are sometimes obtained by small doses of the 
tincture — ten minims — administered at bedtime. Impaction of the 
cmcum, when inflammation has not occurred, may be removed, and 
the bowels induced to act, by small doses, frequently repeated, of the 
tincture of lobelia (two drops every hour). This remedy can be used 
when purgatives would produce serious mischief. An infusion of lobe- 
lia as an enema has succeeded in relieving strangulated hernia, intus- 
susception, and fecal impactions. This use of the agent is the same as 
for the corresponding administration of tobacco ; it is much safer than 
tobacco, and may be used to produce as decided therapeutic effects. 

Unquestionably the most important application of lobelia is to the 
treatment of the asthmatic paroxysm. It gives relief in a few minutes 



HYDROCYANIC ACID. 585 

to violent attacks of spasmodic asthma, and it sometimes happens that 
the relief is permanent. Frequent repetition of this remedy in the 
same individual, however, lessens its effects, and it may finally cease to 
afford any relief. To be effective in asthma, a teaspoonful dose of the 
acetum or tincture must be administered every fifteen minutes until 
nausea is induced. Free expectoration and abundant gaseous eructa- 
tions take place, and the breathing soon becomes easy and calm. The 
efficiency of lobelia is increased by the addition of iodide and bromide 
of ammonium. IJ Tinct. lobelias, § j ; ammonii iodidi, 3 ij ; ammonii 
bromidi, 3 iij ; syrup, tolutan., § ij. M. Sig. : A teaspoonful every 
one, two, three, or four hours. 

Whooping-cough, especially after the cessation of the catarrhal 
stage, has been treated successfully by lobelia, but we now possess 
other agents more effective and less disagreeable in action. Lobelia is, 
however, an excellent expectorant. It is adapted to cases in which the 
cough is dry, resonant, and spasmodic. It succeeds best in those who 
have attacks of cough with spasmodic difficulty of breathing, and 
who get up a little tough mucus after long and painful paroxysms of 
coughing. 

A lobelia-emetic will cut short an attack of spasmodic croup, but 
it is too harsh and dangerous a remedy to be employed for this pur- 
pose. 

Lobelia may be used instead of tobacco in tetanus, strychnine-poi- 
soning, and allied states. 

Authorities referred to : 

Fluckiger and Hanbury. Pharmacographia, p. 357. 

Ott, Dr. J. Note on the Action of Lobelina on the Circulation. (Reprinted from the 
Boston Medical and Surgical Journal.) 

Porcher, Dr. Francis Peyre. Resources of the Southern Fields and Forests, p. 438. 
Stille, Dr. A. Therapeutics and Materia Medica, fourth edition, vol. ii, p. 354. 

Acidum Hydrocyanicum. — Hydrocyanic or Prussic Acid. Acide 
hydrocyanique, Fr.; Blausaure, Ger. 

Acidum Hydrocyanicum Dilutum. — Diluted hydrocyanic acid. A 
colorless liquid, having a peculiar odor, and wholly volatilized by heat. 
It imparts a faint, evanescent red color to litmus, and is not discol- 
ored by hydrosulphuric acid. With solution of nitrate of silver, added 
in slight excess, one hundred grains of it produce a white precipitate, 
which, when washed with water until the washings are tasteless, and 
dried at a temperature not exceeding 212°, weighs ten grains, and is 
wholly soluble in boiling nitric acid. 

The official diluted acid contains two per cent of anhydrous acid 
and ninety-eight per cent of alcohol and water. (U. S. P.) Dose, Tf[ j 
— ni v. 

Antagonists and Incompatibles. — The metallic salts are, gener- 



586 MOTOR DEPRESSANTS. 

ally, incompatible ; also the red oxide of mercury and the sulphides. 
Freshly-precipitated oxide of iron (hydrated sesquioxide) has been 
proposed as a chemical antidote, but its action is too slow. In cases 
of poisoning, the remedies of the greatest utility are cold affusion 
to the spine, the inhalation of ammonia, the stomach administration, 
as also the intra-venous injection of this substance, and the subcutane- 
ous injection of ether. Atropine has been proposed as a physiological 
antagonist by Preyer ; but the rate at which atropine is diffused, as 
compared with the diffusion of prussic acid, obviously will render 
such antagonism powerless, how much soever it may be approved on 
theoretical grounds. The results of experiments, as the author and 
others have shown, are, however, opposed to the existence of this 
antagonism. In addition to these measures, artificial respiration 
should be practiced. 

Physiological Effects. — Applied to the unbroken skin, it is 
doubtful whether hydrocyanic acid is absorbed, but in contact with a 
wound or an abrasion, and with the mucous membrane, it diffuses into 
the blood with great rapidity. 

The vapor has a rather fragrant odor, similar to that of bitter al- 
monds. Inhaled, it has speedily caused death. When the effects of 
the vapor are short of lethal, giddiness, faintness, embarrassed breath- 
ing, a weak, small pulse, and great muscular weakness, are produced ; 
and there may be even coma and profound insensibility, and yet re- 
covery ensue (Taylor). 

In small medicinal doses, beyond a fugitive and very slight calma- 
tive effect, no symptoms are produced by it. When the dose some- 
what exceeds the medicinal standard, there may occur transient gid- 
diness, nausea, faintness, a feeble pulse, and general muscular weak- 
ness. The effects follow very speedily. When a very large toxic 
dose is taken, a few seconds only intervene from the act of swallowing 
until its effects are manifest, and death may ensue in two minutes or 
be postponed to five. Under these circumstances, the following phe- 
nomena have been observed : sudden insensibility ; eyes protruding 
and glistening ; pupils dilated and unaffected by light ; extremities 
cold, relaxed ; the skin covered with a clammy sweat ; breathing con- 
vulsive, slow ; the pulse extremely feeble or imperceptible ; evacua- 
tions involuntary (Taylor). When the effects are slower, in conse- 
quence of the ingestion of a merely lethal dose, there are occasionally 
tetanic convulsions, opisthotonos, trismus, etc. 

Although the effects of prussic acid are exceedingly rapid, a fatal 
result is not instantaneous. Various acts of volition may be gone 
through, provided but a few seconds are required for their perform- 
ance. Several instructive instances of this kind are narrated by Tay- 
lor. The effects of hydrocyanic acid are not more rapid than can be 
accounted for by its distribution through the blood. 



HYDROCYANIC ACID. 587 

Most contradictory opinions have been expressed as to the action 
of prussic acid on the blood : that it at first arterializes and afterward 
arrests decarbonization of the blood ; that it destroys the ozonizing 
power, and does not impair the capacity of the red blood-globules to 
carry and to yield up oxygen ; that cyanohaemoglobin is formed by 
the combination of the acid with haemoglobin, and that this combina- 
tion can not take place, owing to the rapidity of the action of the 
poison. From this chaotic state of scientific opinion the following 
may be evolved : the blood is dark, owing to deficient decarbonization, 
but this is probably due to a spasm of the pulmonary arterioles and 
paresis of the muscles of respiration, whence it follows that rapid as- 
phyxia ensues. The primary action of prussic acid on the terminal 
filaments of the pneumogastric, as shown by Preyer, is confirmatory 
of this view. 

Although the action of the heart ceases after respiration, prussic 
acid undoubtedly exerts a direct paralyzing action on the cardiac 
ganglia. 

The cerebral effects of this poison are, probably, indirect, the re- 
sult of rapid carbonic-acid poisoning, and the sudden withdrawal of 
oxygen from the cerebral tissues. Direct application of prussic acid 
to the medulla oblongata causes (in the alligator) a sudden and com- 
plete expiration, and collapse of the lung (Jones). The tetanic con- 
vulsions which have been observed in many cases of poisoning, in ani- 
mals and in man, indicate a direct action of this agent on the spasm- 
center ; but the disappearance of the excitability of the motor nerves, 
and of the contractility of muscles which it causes, shows that it 
quickly exhausts the irritability of the spinal cord. These effects on 
the cord, on the nerve-trunks, and on the muscles, are also, probably, 
in part due to the circulation through them of blood deprived of oxy- 
gen and charged with carbonic acid. The fact that instances of re- 
covery from a condition of profound insensibility are numerous, is con- 
firmatory of the view just expressed. Moreover, artificial respiration 
exerts an undeniable influence over the lethal effects of the acid in ani- 
mals (Preyer), whence it may be concluded that to supply oxygen to 
the blood is sufficient to arrest all of the symptoms produced by the 
want of oxygen and by the excess of carbonic acid. 

Post-mortem rigidity sets in early after death from prussic acid, 
and is very pronounced. The fingers are tightly closed, the toes 
strongly flexed, the jaws rigid, the eyes prominent and staring. The 
blood is dark-colored, fluid, and the venous trunks and the cerebral 
sinuses are gorged. 

The quantity of medicinal, diluted hydrocyanic acid necessary to 
produce death will vary with the age, size, and bodily vigor. Habit, 
also, influences to a remarkable degree the susceptibility to its toxic 
influence. A quantity equivalent to forty minims of the diluted hy- 



588 MOTOR DEPRESSANTS. 

drocyanic acid (United States Pharmacopoeia) has proved fatal. As 
the effects of a medicinal dose are expended in a half hour to one hour, 
the repetition of the doses hourly will not be unsafe. Hydrocyanic 
acid is not a cumulative poison. 

Theeapy. — Hydrocyanic acid is a remedy of very considerable util- 
ity in certain affections involving the functions of the pneumogastric 
nerve. It is often highly serviceable in various kinds of nervous vom- 
iting ; for example, the vomiting of pregnancy, the vomiting which 
accompanies some cerebral disorders, and the reflex vomiting of phthi- 
sis. The good effects are quickly, if at all, produced ; hence, if no 
result is attained after some days' administration, no advantage can 
be expected from its continued administration. 3 Acid, hydrocyan. 
dil., 3 j ; aquae laur.-cerasi, 1 ij. M. Sig. : A teaspoonfid every two 
to four hours. 

Gastralgia, when it is a truly neuralgic affection of the gastric 
nerves, is occasionally very quickly cured by this agent. Sometimes 
cases, apparently in every way suitable for its use, are not improved 
by it. If a few doses do not effect any amelioration, it will be useless 
to continue it. Cases of indigestion accompanied by pain in the 
nucha, and attacks of giddiness (stomachal vertigo), are sometimes re- 
markably relieved by prussic acid. Irritative dyspepsia, manifested 
by these symptoms, a red-glazed tongue, pain, epigastric tenderness, 
and a feeling of weight and oppression, may be, not unfrequently, 
much benefited, and, indeed, cured ; but while the results are often 
brilliant, failures are also frequent. Enteralgia, a malady often ex- 
tremely rebellious to remedies, not unfrequently yields promptly to 
prussic acid. 

Considerable medicinal doses of this agent are very fatal to round 
worms (lumbricoides). 

Hydrocyanic acid is a successful remedy in whooping-cough, after 
the subsidence of the catarrhal symptoms. It acts by allaying irrita- 
bility of the pneumogastric, and is successful just in proportion to the 
preponderance of the nervous symptoms. The cases in which the au- 
thor has witnessed the best results were cases of cough by habit, after 
the cessation of the whooping-cough proper. The nervous cough of 
mothers, which exists during the presence of whooping-cough in the 
household, may be allayed by this agent. I£ Acid, hydrocyan. dil., 
3 j ; tinct. sanguinariae, 3 iv ; syrp. senega?, f ss ; syrp. tolutan. , 1 ij ; 
aquae lauro-cerasi, 3 vij. M. Sig. : One or two teaspoonfuls, accord- 
ing to age, every three or four hours. For irritable cough. It some- 
times happens that this agent will greatly relieve the cough of phthisis, 
but only when it is chiefly nervous. 

To allay cerebral irritation and excitement, prussic acid has been 
employed with benefit (McLeod). In forty cases of mental disorder ob- 
served by McLeod, there was "slight or temporary amelioration" in 



CYANIDE OF POTASSIUM. 589 

ten ; a " more decided and permanent effect," the disease being still sta- 
tionary or progressive, in nineteen ; and in eight cases, six of acute 
mania, and two of acute melancholia, " the drug has been a factor, and 
a very main one, in rapid restoration to reason." In the treatment of 
these cases, McLeod used from two to five minims of Scheele's dilute 
acid, which contains five per cent of anhydrous acid. His method of 
administration consisted in giving it at first at short intervals (every 
quarter of an hour), and, when effects were produced, every hour or 
two. He also employed it subcutaneously, in five-minim doses. 

External Uses. — In various cutaneous diseases characterized by 
itching, the local application of prussic acid affords relief. The follow- 
ing formulae, from Fox, represent serviceable combinations : ^ Bi- 
chloride of mercury, gr. j ; dilute hydrocyanic acid, 3 j ; emulsion of 
almonds, § vj. M. Use in itching, in lichen, in the syphilodermata. 
3 Dilute hydrocyanic acid, 3 ss to 3 j ; infusion of marsh-mallow, § v 
to 1 viij. M. Use in pruritus. ^ Acetate of ammonia, ^ j ; dilute 
prussic acid, 3 jss ; infusion of tobacco, § viij. M. Sig. : To be sponged 
on the part twice a day in pruritus ani or p. vulvm. I£ Borax, 3 j ; 
prussic acid, 3 ij ; rose-water, § viij. M. In the pruritus of old people. 

Authorities referred to : 

Amory, Dr. Robert. The Boston Medical and Surgical Journal, vol. ii, 1866, p. 73. 
Casper, von Dr. Carl Liman. Gericht. Medicin., zweiter Band, p. 521. 
Hermann, Dr. L. Lehrbuch der experimentellen Toxicologic, Blausdure, p. 288. 
Hoppe-Setler. Archiv fur path. Anat., Band xxxviii, p. 435. 
Ibidem. Tubinger med. chern. JInter., p. 206. 
Husemann, Dr. Theod. Handbuch, etc., zweiter Band, p. 1136. 
Jones, Dr. Joseph. The Medical Record, New York, vol. ii, p. 459. 
Kolliker, Prop. Dr. Archiv fur path. Anat., Band x, p. 272. 

Lecorche et Meuriot, MM. Archives Generates de Med., tome xi, 6 ser., p. 530, 
et seq. 

McLeod, Dr. Kenneth. The Medical Times and Gazette, vol. i, 1863, p. 262. 
Preyer, Dr. W. Die Blausdure, phys. Untersucht, Bonn, 1868-"70. 
Taylor, Dr. A. S. On Poiso?is, third London edition, p. 585, et seq. 

Potassii Cyanidum. — Cyanide of Potassium. In white, opaque, 
amorphous pieces, having a sharp, somewhat alkaline and bitter-almond 
taste, and an alkaline reaction. It is deliquescent in moist air, readily 
soluble in water when reduced to powder, and sparingly soluble in alco- 
hol. Dose, gr. A— gr. f (IT. S. P.) 

Antagonists and Incompatibles.— Acids decompose it and set 
free hydrocyanic acid. As respects its physiological properties, its an- 
tagonists are the same as those of hydrocyanic acid. 

Synergists. — Same as for hydrocyanic acid. 

Physiological Actions. — The effects of this salt have been already 
mentioned in sufficient detail in the preceding article, so far as they 
correspond to hydrocyanic acid. It has, however, some special physical 



590 MOTOR DEPRESSANTS. 

properties which separate it slightly from the powerful agent which en- 
ters into its composition. 

Applied to the unbroken epidermis, the cyanide of potassium 
produces at first a sensation of coldness, followed by tingling and 
itching, and in a half-hour the skin is found to be somewhat red- 
dened. Prolonged contact produces a phlyctenular or eczematous 
eruption. 

Systemic effects are produced by the local and external use of the 
cyanide of potassium, viz., slowing of the pulse and respiration, mus- 
cular weakness, drowsiness, and coldness. Lethal effects may follow 
prolonged contact with the skin, even when the epidermis is unbroken. 
Applied to a wound or abraded surface, this salt causes a burning pain, 
excites a high degree of inflammation, and produces prompt lethal 
effects. 

Therapy. — Cyanide of potassium may be prescribed as a substitute 
for hydrocyanic acid in all of the maladies for which the latter is used. 
This salt has, however, some special applications which we owe to 
Trousseau. This eminent observer has shown that a solution of the 
cyanide applied to the seat of painful sensations gives great relief in 
various forms of reflex headache, gastric, cardiac, pulmonary, and men- 
strual. The headache which accompanies the pyretic state is, accord- 
ing to the same authority, cured or greatly alleviated by the cyanide 
solution, while at the same time a favorable influence is exerted over 
the temperature. $ Potassii cyanidi, gr. x — 3 j ; aquae lauro-cerasi, 
§ iv. M. Sig. : A compress, moistened with the solution, to be applied 
to the seat of pain. From a quarter to a half hour of contact with the 
skin usually suffices. 

A solution of the cyanide of potassium, of the strength given above, 
will remove the stains of nitrate of silver, and also the dissecting-room 
odor, from the hands. 

Cyanide of potassium, in the form of ointment or solution, is an ex- 
cellent remedy for allaying irritation in various cutaneous diseases. In 
pruritus and urticaria, the following formula (McCall Anderson) gives 
relief : fy Potassii cyanidi, gr. vj ; pulv. cocci, gr. j ; ung. aq. rosse, 
§ j. M. Sig. : Ointment. In eczema with pruritus, the same authori- 
ty recommends the following : I£ Potassii cyanidi, gr. v ; sulphuris, 
potassii bicarb., aa 3 ss ; pulv. cocci, gr. vj ; axungise, J j- M. Sig. : 
Ointment. A solution of the cyanide of potassium is one of the most 
effective applications for that very troublesome disorder, pruritus pu- 
dendi. ]J Potassii cyanidi, gr. xv ; aquae lauro-cerasi, § viij. M. 
Sig. : Lotion. This formula is also serviceable in lichen and prurigo 
(Hardy). 

Entomologists make use of the cyanide to destroy insects without 
injuring their structures. One part of the cyanide, two parts of plas- 
ter of Paris, and one and a half part of water, made into a paste and 



NITRITE OF AMYL. 591 

poured into a wide-mouthed bottle, sets into a solid mass, which gives 
off the vapor of hydrocyanic acid (Squire). 

Authorities referred to : 

Trousseau et Pidoux. Traite de Therapeidique, etc., vol. ii, p. 265, el seq. 
Trousseau, A. Clinique Medicale, vol. ii, p. 332. 

Amyl Nitris. — Nitrite of amyl. JVitrite cVamyle, Fr. ; Amylni- 
trit, Ger. 

Properties. — A yellowish or reddish-yellow liquid, rather oily in 
consistence, very volatile, and having a peculiar and very diffusive 
ethereal odor. It is insoluble in water, but soluble in all proportions 
in alcohol, ether, chloroform, benzol and benzin. It has a neutral or 
a slightly acid reaction. It may contain, as impurities, nitric acid, amyl- 
nitric ether, amylvalerianic ether, and hydrocyanic acid. The specific 
gravity is "877. Dose, ttj, ij — ttj, v, by inhalation or subcutaneously. 

Antagonists. — The actions of the nitrite of amyl are antagonized 
by all those agents which increase the functional activity of the spinal 
cord and sympathetic — as strychnine, brucine, picrotoxin, digitalis, 
ergot, belladonna, and, as McCullough has shown, it is an efficient 
remedy in chloral - poisoning. The opposing action of amyl nitrite 
and ergot has been demonstrated clinically by Dr. Fancourt Barnes, 
in cases of hour-glass contraction induced by ergot. This antago- 
nism may not be available, owing to the difference in the rate at which 
they are diffused, to affect the system. 

Synergists. — All of the motor depressants increase the effects of 
the nitrite of amyl. 

Physiological Actions. — The following are the symptoms pro- 
duced by nitrite of amyl when inhaled : acceleration of the action of 
the heart ; sudden flushing of the face ; dilatation of the arterioles in 
consequence of paresis of the muscular layer of these vessels ; a 
sense of extreme fullness of the brain, with vertigo ; fall in the blood- 
pressure ; lowering of the temperature ; complete resolution of the 
muscular system of animal life. The vapor of nitrite of amyl ap- 
plied directly to the tissues — muscular or nervous — suspends or com- 
pletely arrests functional activity. Circulating in the blood, it un- 
doubtedly affects most the vaso-motor nervous system and unstriped 
muscular fiber. 

The marked acceleration of the heart (Pick) is in part consecutive, 
doubtless, to the sudden dilatation of the arterioles, permitting such 
an increased quantity of the blood to enter these vessels as to require 
renewed effort on the part of the heart to supply it ; in part also to 
the paretic state which it induces in the inhibitory apj:>aratus. The 
great fall in the blood-pressure noted by Brunton, Wood, and Amez- 
Droz, is also due to dilatation of the arterioles, and consequent dimi- 



592 MOTOR DEPRESSANTS. 

nution of tension in the peripheral vascular system. Dilatation of 
the retinal vessels, when nitrite of amyl is inhaled, has been ascer- 
tained by ophthalmoscopic examination (Aldridge). 

On the nervous system of animal life the nitrite of amyl acts as a 
depressant — impairing motility first, and, at the last, sensibility. It 
affects both the spinal cord and the nerves, lessening the sensibility 
to all forms of irritation, and diminishing the reflex functions. It also 
impairs the contractility of muscle. Death ensues from failure of res- 
piration, and the cerebral functions are unaffected until carbonic-acid 
poisoning ensues. 

Decided lowering of temperature is produced by the nitrite of 
amyl. This result is no doubt due to the action of this agent on the 
haemoglobin, whereby the carrying capacity of the red blood-glob- 
ules of oxygen is lessened (Gamgee), metamorphosis of tissue is in- 
terfered with, and the generation of animal heat is diminished. A 
peculiar change ensues in the color of the blood as a result of the 
lessened oxygenation : all the blood of the body assumes a modified 
venous hue. 

A curious fact has been noted by Hoffmann, viz. : the hypoder- 
matic injection of lethal doses of nitrite of amyl produces in rabbits a 
temporary glycosuria. 

Therapy. — The applications of the nitrite of amyl in the treat- 
ment of disease have been deduced from a study of its physiological 
actions. It is especially indicated when morbid symptoms result 
from vaso-motor spasm. It has been shown that epileptic attacks 
may be warded off by the inhalation of nitrite of amyl at the begin- 
ning of the movement of the aura. Patients who have a distinct 
warning of the seizures should be constantly provided with a small 
quantity of this remedy in order to practice the inhalation whenever 
an attack is impending. The mechanism of the action is very simj)le : 
the vaso-motor spasm of the cerebral vessels, which is the initial 
symptom of an epileptic convulsion, is relaxed, and the vessels dilated 
by the nitrite of amyl. 

By the timely inhalation of the nitrite, the cold stage of an ague 
may be aborted, but the hot stage is not modified in any way (Price, 
Ziegler). This power may be most serviceable in cases of pernicious 
intermittent, the danger of which consists in the extreme depression 
of the cold stage. The cardiac failure caused by chloral, chloroform, 
and other heart-poison, and the condition of sudden weakness which 
may ensue from various causes, in cases of fatty heart, are often re- 
markably relieved by the inhalation or hypodermatic injection of amyl 
nitrite. 

An attack of migraine, of that form characterized by vaso-motor 
spasm (pallor of the face), may be quickly relieved and sometimes 
aborted by the inhalation of two or three drops of amyl nitrite. 



NITRITE OF AMYL. 593 

When there are redness of the face, injection of the conjunctivae, and 
fullness of the cerebral vessels, this remedy is contraindicated. 
Cases of neuralgia of the fifth nerve, second division, have been 
cured by inhalation of amy], repeated from time to time as the pain 
required its administration. 

Asthma, when purely spasmodic, is usually quickly checked by 
this remedy. The paroxysms of difficult breathing which accompany 
emphysema and cardiac disease are not relieved in this way ; indeed, 
the author has known the most serious distress to be produced by the 
inhalation under these circumstances. 

Exaltation of the reflex function of the spinal cord and muscular 
spasm are morbid states in which good results may be expected from 
inhalation of the nitrite of amyl. It has been used with success in 
tetanus. It should also be fairly tried in strychnine-poisoning and in 
hydrophobia. Michael has administered it in tinnitus aurium, a most 
obstinate and distressing condition, with comparatively good effects : 
of a group of thirty-three cases, nineteen were distinctly benefited. 

Most signal relief has been obtained from the inhalation of amyl 
nitrite in angina pectoris. We owe this important suggestion and 
practice to Brunton, who had ascertained that when the paroxysm of 
angina pectoris occurs, a great rise of arterial tension takes place. 
When the pain, precordial distress, and anxiety are felt, there should 
be no delay in the use of the remedy. Some cautions are, however, 
needed. It may be unsafe when advanced degeneration of the cere- 
bral vessels exists (Anstie). Fatty degeneration of the heart, which 
is so frequently a cause or an accompaniment of angina pectoris, may 
also render the use of so powerful a paralyzer of doubtful expediency. 

Dr. Mary Putnam Jacobi has found the inhalation of nitrite of 
amyl very serviceable in neuralgic dysmenorrhea. As an antagonist 
to ergot, it may prove in a high degree useful, when ill effects are 
caused by this remedy. Thus, in a case of hour-glass contraction pro- 
duced by ergot, the inhalation of amyl nitrite procured immediate re- 
lief. On theoretical grounds this agent was proposed for the relief of 
cholera asphyxia (Brunton, Gamgee), but the trials thus far made 
with it have demonstrated its inutility. Owing to the fact, shown by 
Gamgee, that nitrite of amyl combines with haemoglobin, Brunton pro- 
poses that this remedy, if given at all in cholera, must be administered 
by the stomach or by subcutaneous injection, and not by inhalation. 

Repetition in the use of the nitrite of amyl diminishes its effects, 
and hence increasing doses are necessary when it is often employed in 
the same case. 

Authorities referred to : 

Aldridge, Dr. Charles. The West Riding Lunatic Asylum Medical Reports, vol. i, 
p. 97. 

Amez-Droz, Dr. Archives de Physiologie Normale ct Pathologique, 1873, p. 467. 
38 



594 MOTOR DEPRESSANTS. 

Anstie, Dr. F. E. Transactions of Clinical Society. Lancet, March 5, 1870. 
Brunton, Dr. T. L. The British Medical Journal, July 13, 1872. Ibid., The Lancet, 
July 27, 1867. 

Gamgee, Dr. Arthur. Philosophical Transactions, 1868, p. 589. 

Haddon, Dr. John. Edinburgh Medical Journal, July, 1870, p. 45. 

Jacobi, Dr. Mary Putnam. The Medical Record, New York, January 15, 1875. 

Mitchell, Dr. S. Weir. The Philadelphia Medical Times, vol. v, p. 553. 

Wood, Dr. H. C. American Journal of the Medical Sciences, July, 1871. 

Nitro-Glycerinum. — Nitroglycerin. (Not official.) 

Properties. — Nitro-glycerin is an oily liquid, colorless, or pale yel- 
low, and has the specific gravity 1*60 at 59° Fahr. It burns quietly in 
the open air, but heated in a close vessel, or subjected to percussion, 
it explodes violently. It decomposes if long kept. It is very slightly 
soluble in water, but dissolves freely in alcohol and in ether. The 
best preparation for administration is the alcoholic solution — one part 
of nitro-glycerin to one hundred parts of alcohol. The dose of this 
ranges from one minim to many minims. As the susceptibility to this 
agent varies greatly, the initial dose should be the smallest. One 
minim of the one-per-cent solution will give some persons violent 
headache, while others may take a minim of the undiluted drug with- 
out any decided effect. 

It should not be forgotten that the alcoholic solution will explode 
if struck with a wet hammer. 

Sodii Nitris. — Nitrite of soda. 

JPotassii Nitris. — Nitrite of potassium. These salts have been pro- 
posed and used as substitutes for amyl nitrite and nitro-glycerin. Dose, 
g r - iij— gr- viij. 

Ethyl nitrite is the most important constituent of nitrous ether. 
Inhaled, it has effects similar to the other nitrites. 

Antagonists. — All those agents which increase the reflex activity 
of the spinal cord and stimulate the vaso-motor system, as strychnine, 
ergot, digitalis, belladonna, etc., antagonize nitro-glycerin. 

Synergists. — Amyl nitrite acts very similarly, and the motor de- 
pressants in general promote the actions of nitro-glycerin. 

Physiological Actions. — The taste of nitro-glycerin is at first 
sweetish, but this impression is followed by aromatic pungency. In a 
few minutes — from three to five — after a small medicinal dose, there 
are suddenly experienced a feeling of giddiness, tension of the head, 
with fullness, languor, nausea, and sometimes stomach - pain. Such 
effects are experienced from a small dose, if the individual taking it 
is susceptible. It follows, then, that the quantity of nitro-glycerin 
causing such symptoms must vary in different patients. Dr. Harley 
experienced these effects after taking fifteen drops. Dr. Fuller expe- 
rienced some fullness of the head, perspiration, intermittent pulse, and 
some after-headache, from a dose equivalent to fifty minims of a one- 



NITRO-GLYCERIN. 595 

per-cent solution, or a half -drop of the nitro-glycerin itself (Murrell). 
In some persons a drop or two of the one-per-cent solution will cause 
dizziness, faintness, a rapid and very weak pulse, perspiration of a 
rather clammy character ; or, indeed, the symptoms may proceed to 
unconsciousness. Dr. Murrell applied the moistened cork of the bottle 
containing the solution to his lips, and in a few minutes experienced a 
tremendous action of the heart and arterial system ; his pulse rose to 
100 and higher, and he had " a splitting headache " for some time. 
There is no change in the temperature. Women and the feeble in 
constitution suffer more decided effects than the robust. Drowsiness 
comes on, with a feeling of languor, in those on whom the smallest 
dose acts kindly. With the rapid pulse is a considerable degree of 
dicrotism. The change in the character of the pulse begins in about 
six minutes after the dose is taken, and lasts on the whole about one 
hour. The sphygmographic tracings appended to Dr. Murrell's paper 
are remarkable for the extent of the excursions of the lever, the ab- 
rupt ascent, the sharpness of the summit, and the dicrotic rebound, in- 
dicating an extremely low state of the arterial tension. When the 
heart of a frog is put into a '75-per-cent salt solution, and two drops 
of a ten-per-cent solution of nitro-glycerin are added, the heart acts 
more and more slowly, and presently stops. An alcoholic solution 
has no effect (Brunton). When injected into the jugular vein of a 
cat, the nitro-glycerin solution arrests the heart speedily. That the 
vagus is paralyzed, and the inhibition thus removed from the heart, is 
proved by the fact that galvanic excitation of the vagus has no effect 
in restraining the cardiac movements. Changes occur in the blood 
like those induced by amyl nitrite and the nitrites of soda and other 
nitrites ; that is, the blood assumes a chocolate-color, and probably 
loses its power of absorbing and conveying oxygen ; but its so-called 
ozonizing function may not be interfered with, since nitro-glycerin 
does not prevent the guaiac reaction, in which respect it agrees with 
the other nitrites. The change in the color of the blood is produced 
slowly when blood is shaken up with some nitro-glycerin outside of 
the body (Brunton). 

In frogs nitro-glycerin causes weakness, tetanus, ending in paral- 
ysis ; but, in warm-blooded animals, there are convulsive movements, 
as twitching of the muscles, hiccough, spasmodic breathing, etc. The 
tetanus in frogs, according to Brunton, is not due to a direct action of 
the poison on the spinal cord, thus opposing the assumption of Minor, 
who held that it acts on the medulla. The paralyzing effect of nitro- 
glycerin appears to be due to an action on the muscles, and also on 
the motor nerves. When it is applied directly to the muscles, they 
quickly lose their contractility. The reflex function of the cord is 
extinguished first in the parts external to the cranium, the cerebral 
nerves preserving their power to transmit impressions until later. Sen- 



598 MOTOR DEPRESSANTS. 

sation is destroyed by it as well as motility. Death is due to asphyxia 
— to paralysis of the muscles of respiration. Notwithstanding the 
activity of nitro-glycerin, the most serious symptoms are recovered 
from without detriment. Thus Dr. Murrell narrates several cases in 
which unconsciousness was produced without any ill results, except 
some temporary headache. 

THEEAPY.^-Nitro-glycerin is adapted to the treatment of the mala- 
dies in which its congener, amyl nitrite, has proved so effective. It 
has the advantages over the latter of being more permanent, more 
readily administered, and more sustained in action. In sea-sickness, 
reflex vomiting, gastralgia, hepatic colic, and other painful and spas- 
modic affections of the digestive tube, it may afford very prompt re- 
lief. It was first employed in the treatment of angina pectoris, in 
which it gives as much relief as does amyl nitrite, but the latter should 
be preferred when the utmost promptitude of action is necessary. The 
form of the disease requiring this medicine is that characterized by 
high tension of the peripheral vessels, which is doubtless the condition 
in the genuine cases of angina pectoris. Yery prompt relief may be 
given to attacks of hiccough by this medicine. Some cases of spas- 
modic asthma are much benefited by it. The less there is of struc- 
tural alterations, the more certain the relief. As the secretions of the 
mucous membrane of the respiratory tract are increased by it, the 
cases with deficient secretion are those most certain to be benefited. 
It should be carefully tried in whooping-cough and in laryngismus 
stridulus. There is much to be expected from nitro-glycerin in dis- 
eases of the nervous system characterized by heightened reflexes. An 
attack of epilepsy may be aborted by its timely administration, and 
Hammond finds it as a remedy for this disease second only to the bro- 
mides. By preventing the spasm of the vessels and consequent sud- 
den anaemia of the brain, the first and most important event in the 
series can not occur. It should be fairly tried in tetanus and hydro- 
phobia. In neuralgia of the fifth nerve it has given immediate relief 
in numerous instances. It is the most appropriate remedy in that form 
of migraine, or sick-headache, in which the vessels are in a condition 
of spasm, but is not proper in those cases having a flushed face from 
dilated vessels. 

The cold stage of an intermittent may be aborted by the timely 
administration of nitro-glycerin. It promises to be especially useful 
in the pernicious malarial diseases to prevent the dangerous depression 
of the cold stage. In these cases its administration should be so timed 
that the physiological effect of the remedy occur at the onset of the 
cold stage of the disease. The mechanism of its curative action is 
obvious. Remarkable results have lately been obtained from this 
remedy in acute and chronic Brighfs disease (Robson) — results which 
the author is able, from personal observations, to confirm. It is well 



ACONITE. 597 

known, of course, that high arterial tension is present ; but whether 
as causative of the renal changes, or a consequence of them, is not 
known. The apparently constant association of degenerative changes 
in the renal ganglia with the lesions of Bright's disease, discovered by 
Da Costa and Longstreth, would indicate that the state of the vessels 
is a factor in developing the structural alterations. The manner in 
which nitro-glycerin affords relief, and possibly effects a cure, is thus 
fully explained. Indeed, all of the curative results obtained from nitro- 
glycerin must be referred to its action on the vascular apparatus. 

Authorities referred to : 

Brunton, T. Lauder. St. Bartholomew's Hospital Reports, vol. xii, p. 140. Prelimi- 
nary Notes on the Physiological Action of Nitro- Glycerine. 

Minor, Dr. A. J. Journal of Nervous and Mental Diseases, vol. Hi, p. 355. 

Murrell, Dr. William. The Lancet, 18*79, pp. 80, 113, 225. 

Robson, Mr. Mayo. The British Medical Journal, November, 1880, p. 803. 

Aconitum. — The tuberous root of Aconitum napellus Linne (Nat. 
Ord. Ranunculacece). (IT. S. P.) Racine d^aconit, Fr. ; Eisenhut- 
hiollen, Ger. 

The Indian aconite-root, or bish, is supposed to be more powerful 
than the root of Aconitum napellus, and is preferred for the manufac- 
ture of aconitine (Fltickiger and Hanbury). 

Abstractum Aconiti. — Abstract of aconite. Dose, gr. ss — gr. j. 

Extr actum Aconiti Fluidum. — Fluid extract of aconite. Dose, 

m j— m v. 

Mctractum Aconiti. — Extract of aconite. Prepared from the leaves. 
Dose, gr. -J- to gr. ss. 

Tinctura Aconiti Radicis. — Tincture of aconite-root. Dose, tt[ j 
— m v. 

Composition. — The principal alkaloid is aconitia or aconitine, 
which exists in two forms, crystalline and amorphous, and forms with 
acids cry stalliz able salts. The crystalline form of aconitine is soluble 
in chloroform, ether, and alcohol. Aconite contains also another alka- 
loid which has received various designations — pseuclo-aconitine, na- 
pelline, nepalline, etc., which is closely allied to aconitine, and is found 
in commerce under this name. It is but slightly soluble in chloro- 
form, ether, and alcohol, and it exists also in two forms, crystalline 
and amorphous. Besides the foregoing, another base has been dis- 
covered, to which the name napelline has also been given (Hiibsch- 
mann). This is an amorphous alkaloid, having strong basic proper- 
ties, soluble in water, chloroform, and alcohol, but not soluble in ether. 

These basic substances are united with a peculiar acid — aconitic 
acid. 

Antagonists and In compatibles. — Alcohol, ether, ammonia, tur- 
pentine, digitalis, heat, etc., antagonize the actions of aconite. In cases 



598 MOTOR DEPRESSANTS. 

of poisoning, the stomach should be evacuated, stimulants adminis- 
tered by the stomach and rectum, and external warmth applied. Digi- 
talis has been used with considerable advantage (Fothergill). The 
intra-venous injection of ammonia may be practiced, and artificial res- 
piration resorted to. To overcome the depression of the heart's ac- 
tion, which is the capital point, the hypodermatic injection of atropine 
is indicated. As the chief danger consists in failure of the heart's ac- 
tion, the recumbent position should be strictly maintained. 

Synergists. — All the agents of this group increase the effects of 
aconite. Cold, fatigue, and all depressing emotions, are also syner- 
gistic. 

Physiological Actions. — A drop of tincture of aconite placed on 
the tongue excites a warm and pungent sensation, followed by persist- 
ent tingling and numbness. Prolonged contact with the skin causes 
similar effects upon the sensory nerves. During the medicinal adminis- 
tration of aconite in considerable doses, irritation and a sense of constric- 
tion of the fauces are experienced. Large medicinal doses produce 
gastric pain, nausea, and even vomiting. When the gastro-intestinal 
mucous membrane is in an irritable state, aconite impairs the appetite, 
hinders the digestion, and causes diarrhoea, and in the normal state of 
the membrane, increases its secretions and hastens the peristaltic move- 
ments. 

The systemic effects of aconite follow within a half -hour after its 
administration. The number and force of the heart-beats are reduced, 
and the arterial tension is lowered. The action of the skin is increased, 
and a more abundant urinary discharge takes place. If the quantity 
has been a full medicinal dose, some muscular weakness, tingling in 
the tongue, lips, and extremities, are also experienced. The whole du- 
ration of the effect is about three hours. When a lethal dose is swal- 
lowed, the symptoms begin in from five minutes to a half -hour. In a 
medical student, who swallowed by mistake a teaspoonf ul of the tinc- 
ture of the root, the symptoms began after he had reached the college, 
having walked from his quarters — the time being about twenty min- 
utes. He experienced an overpowering sense of fatigue in the lower 
extremities, and he felt, also, great muscular weakness. His eyesight 
became dim, the globes rather prominent, the pupils dilated. He expe- 
rienced great dyspnoea, and his respirations were shallow and labored. 
The pulse was at first slow and small, and at last became imperceptible. 
The surface of the body, the tongue, and breath, were cold. The 
skin was covered with a profuse sweat. He was restless, anxious, and 
sighed frequently ; but he had no stupor or convulsions. There were 
also decided numbness and tingling in the extremities, and in the 
tongue and lips. Tactile impressions were very faint, and the sense 
of pain was greatly reduced, so that he seemed almost unconscious of 
irritants. His temperature fell 2° Fahr. Under the use of heat, bran- 



ACONITE. 599 

dy, and ammonia, he revived in the course of six hours, and, on the 
following day, although weak, there were no indications of the effects 
of the poison. 

Aconite affects the sensory nerves before the motor. It paralyzes 
first the end-organs, next the nerve-trunks, and finally the centers of 
sensation in the cord. Aconite also impairs the reflex function of the 
spinal cord ; but this effect is, doubtless, secondary to the sensory 
paralysis. The power of voluntary movement continues after the cessa- 
tion of the reflex functions ; but it is finally lost. The arrest of motil- 
ity is due to the action of the poison on the motor centers of the cord, 
and subsequently on the nerve-trunks. 

Aconite, applied directly to the heart, lessens the number and force 
of its beats, and finally arrests its action in the diastole. The cardiac 
muscle, after the cessation of its movements, does not respond to gal- 
vanic excitation. Aconite lowers the arterial pressure, as well as less- 
ens the force of the heart-beat. From these facts it may be concluded 
that it is a direct cardiac poison, affecting its ganglia and muscle, and 
also a sedative to the vasor-motor nervous system. It is also a respira- 
tory poison, in virtue of its paralyzing action on the muscles of respi- 
ration ; but the action of the heart ceases before the respiratory move- 
ments. 

Aconite increases elimination by the skin and kidneys. With in- 
creased discharge of water, there takes place, also, increased excretion 
of solids. 

Therapy. — The monopoly by homoeopathic practitioners of the use 
of aconite has aroused a prejudice against it, which has discouraged its 
employment. Aconite is, however, an antagonist to the fever-pro- 
cess ; it is not applicable in accordance with the so-called law of simi- 
lars. It is used by these quacks because it is a powerful agent which 
will produce manifest effects in small doses, that may easily be dis- 
guised. 

The author can quite agree with Dr. Ringer in the statement that 
aconite is a very valuable medicine, in the class of cases to which it is 
adapted. It lessens the pulse-rate, lowers arterial tension, diminishes 
abnormal heat ; it therefore antagonizes that condition of the organism 
known as fever. As it also slows the respiratory movements, and thus 
lessens the amount of work done by the breathing apparatus, it is espe- 
cially indicated in inflammatory states of the respiratory organs. As 
it diminishes the sensibility of the sensory nerves, it is useful in certain 
forms of neuralgice. As it induces muscular weakness and lowers the 
activity of the reflex functions, it is indicated in morbid states charac- 
terized by an excess of motor activity. 

Tonsillitis, acute pharyngitis, ulceration of tonsils, when accom- 
panied by fever and elevated arterial tension, are greatly relieved by 
the use of the tincture of aconite. From a half -drop to one drop every 



600 MOTOR DEPRESSANTS. 

half -hour, until an impression is made on the fever-movement, and then 
every hour or two, is the best mode of administration. In acute catarrh 
(nasal and faucial), acute otitis, and in acute catarrhal bronchitis, the 
best results may be obtained by the use of aconite, as above described. 
The author's observations entitle him to speak with confidence of the 
good effects of this remedy in catarrhal and fibrinous pneumonia. It 
is more especially serviceable before exudations have taken place, but 
is not without utility at any stage, provided the inflammatory process 
continues. It not only abates the symptoms, but it favors the removal 
of the products of inflammation, by increasing elimination through the 
skin and kidneys. The use of aconite is not incompatible with the 
employment of other measures which may be needed ; but, generally, 
in fibrinous pneumonia, aconite is sufficient up to the period of crisis. 
The author has witnessed excellent results from the use of aconite in 
small doses frequently repeated (one drop every hour) in lowering the 
temperature of phthisis, especially when new districts of pulmonary 
tissue are invaded by pneumonitis. For the treatment of acute pleuri- 
tis, previous to the stage of effusion, no remedies are more effective than 
aconite and opium. 1} Tinct. aconiti rad., 3 ij ; tinct. opii deodor., 
3 vj. M. Sig. : Eight drops in water every hour or two. If the 
pain is severe, a larger dose of opium should be administered, when 
the effect can be maintained by the quantity directed in the above 
prescription. 

Over action of the heart, icith hypertrophy and without valvular 
lesion, especially if there be present a condition of plethora, is bene- 
fited by a quantity of aconite sufficiently large to moderate the cardiac 
movements. 

Aconite is contraindicated in inflammatory states of the gastroin- 
testinal mucous membrane. It is very serviceable in acute congestion 
of the liver and hepatitis: it diminishes the fever, and, by causing free 
transpiration, lessens the pungent heat of the skin. Peritonitis is best 
treated by a combination of aconite and opium, as described above for 
pleuritis. Generally, the opium needs to be given in somewhat larger 
quantity in peritonitis than in pleuritis. In pelvic peritonitis, puer- 
peral metritis, and peritonitis, aconite is indicated, and is of unques- 
tionable utility, provided there be present a condition of sthenic reac- 
tion. A condition of adynamia, on the other hand, always contraindi- 
cates the use of aconite. 

The simple fevers of childhood, febricula, ephemeral fever, arising 
from various causes, as cold, fatigue, excitement, etc., are best treated 
by small and repeated doses of aconite. The remedy induces sweat- 
ing, and then the fever-movement subsides. The hot stage of intermit- 
tents and remittent fever, if any febrifuge is required, maybe relieved 
of its intensity by frequently-repeated doses of aconite. The continued 
fevers are not benefited by this remedy unless a condition of hyperpy* 



ACONITE. 601 

rexia is threatened, when aconite may be used in connection with other 
antipyretic remedies. 

Aconite possesses the highest value in the eruptive fevers, especially 
in scarlet fever. There are two conditions of this disease especially 
requiring the use of aconite — the eruptive stage, and the period of des- 
quamation, if, as is usual, a marked rise of temperature takes place at 
this period of the disease. Several important purposes are subserved 
by the use of this remedy : it lowers the fever-heat, favors the action 
of the skin and kidneys, and checks the nasal, faucial, and aural in- 
flammations, which constitute such troublesome complications and 
sequelae. The particular utility of aconite in measles consists in its 
power to arrest the catarrhal pneumonia, one of the most serious com- 
plications of this disease. We have no remedy more useful in erysipe- 
las — idiopathic, so called, and not arising from trauma ; but, on the 
other band, Ringer describes an apparently erysipelatous inflammation 
following vaccination, which is quickly cured by aconite. According 
to the author's observations, it is facial erysipelas which is most de- 
cidedly benefited, and cases characterized by sthenic reaction. When 
there is a state of adynamia present, the eruption being dusky and the 
cutaneous circulation languid, belladonna is preferable to aconite. 
When, in acute rheumatism, there are much heat and a dry skin, instead 
of the usual sweating, aconite is very serviceable. It affords very con- 
siderable relief in muscular rheumatism when there is much fever. 

In acute inflammation of the cerebral and spinal meninges, and in 
cerebrospinal meningitis before effusion has taken place, aconite is as 
serviceable as in other acute inflammations. It is generally advisable 
to combine opium with it, especially in cerebro-spinal meningitis. In 
acute maniacal delirium, and in mental disorders generally, when there 
is much motor activity, with vascular excitement and increased ar- 
terial tension, aconite is useful, but is not so effective as gelsemium. 
Aconite renders important service in the active form of acute cerebral 
congestion. 

Neuralgia, when accompanied by arterial excitement and muscular 
spasm, is relieved by aconite ; but generally the neuralgias are much 
more successfully treated by hypodermatic injections and galvanism. 

It is asserted by Ringer, and also by Phillips, that sudden suppres- 
sion of the catamenial flow, caused by cold, can be relieved by aconite, 
in drop-doses of the tincture every half -hour or hour. The author can 
assert that this remedy has a high degree of utility in congestive dys- 
menorrhoea, occurring in plethoric subjects. These are cases, also, in 
which gelsemium is so undoubtedly beneficial. 

Aconitine in Trigeminal Neuralgia. — Remarkable results have late- 
ly been obtained by the use of Duquesnel's aconitine in this malady. 
The following formula is proposed by the New York Therapeutical 
Society : 1$, Aconitinse (Duquesnel's), gr. -^ ; glycerini, alcohol., aa 3 j ; 



602 MOTOR DEPRESSANTS. 

aquae menthae pip., ad 1 ij. M. Dose, a teaspoonful. The dose is 
sometimes very slowly and cautiously increased to -J-. Although it 
does not succeed in all cases of tic-douloureux for obvious reasons, it 
relieves remarkably in others (Seguin). 

JVapelline. — Duquesnel has lately rediscovered (?) a principle to 
which he has applied the name napelline. Its physiological actions 
have been studied by Laborde. He finds it weaker than aconitine, 
and was able to administer without ill results from a half (^) grain to 
three fifths (f) of a grain. It possesses valuable hypnotic properties, 
and it is proposed to use it as a substitute for opium and chloral. On 
trial it proved to be an effective remedy in neuralgia, and as a sleep- 
producing agent in cases of wakefulness, mental excitement, and allied 
conditions. If further investigations confirm those observations, it 
will be a valuable addition to the materia medica. 

Authorities referred to : 

Achscharumow, Dr. Archiv fur Anat. und Physiologie, 1866, p. 255. 

Bohm und Ewers. Ueber die phys. Wirk., etc. Archiv fiir experimentelle Pathologie 
und Pharmakologie, 1873, p. 385. 

Fothergill, Dr. J. M. The British Medical Journal, 1870. Ibid., January 17, 1874. 

Hottot, M. Journal de V Anatomic el de la Physiologie, 1864, p. 113. 

Hottot et Liegeois. Ibid., 1861, p. 520. 

Husemann, Drs. Theo. und Aug. Pfanzenstoffe, p. 210. 

Husemann, Dr. Theod. Handbuch der gcsammten Arzneimittelhhre, p. 1153. 

Phillips, Dr. C. D. F. The Practitioner. Ibid., Materia Medica and Therapeutics, 
1874, p. 2. 

Ringer, Dr. Stdney. Handbook of Therapeutics, article Aconite. 

Taylor, Dr. A. S. On Poisons, third London edition, p. 747. 

Van Praag, Dr. L. Archiv fur path. Anat., vii, p. 438. 

Veratrum Viride. — American hellebore. The rhizoma and rootlets 
of Veratrum viride Aiton (Nat. Ord. Melanthacem). (IT. S. P.) 

Extractum Veratri Viridis Fluidum. — Fluid extract of veratrum 
viride. Dose, ttl ij — rrt v. 

Tinctura Veratri Viridis. — Tincture of veratrum viride. Dose, 
HI ij— m v. 

Yeeateina. — Veratrine. An alkaloid or mixture of alkaloids, pre- 
pared from the seeds of Asagroea officinalis Lindley (Nat. Ord. Me- 
lanthacece). Is pulverulent, grayish- white, inodorous, but very irritant 
to the nostrils. It has an acrid, bitter taste, causing a sensation of 
tingling with numbness in the tongue. It is very slightly soluble in 
water, but readily and wholly dissolved by alcohol. It has an alkaline 
reaction. 

Oleatum Veratrinm. — Oleate of veratrine. Yeratrine, 2 parts ; 
oleic acid, 98 parts. (For external use.) 

Unguentum Veratrinm. — Yeratrine ointment. Yeratrine, 4 parts ; 
alcohol, 6 parts ; benzoinated lard, 96 parts. (For external use.) 



VERATRUM VIRIDE. 603 

Composition. — Veratrum album, veratrum viride, and veratrum 
sabadillse, correspond closely in chemical composition, and the first two 
in botanical characteristics. Sabadilla is only used as the source of 
the alkaloid veratrine. The alkaloids of veratrum album arejervi?ie 
and veratralbine (Mitchell). Veratrum viride contains two alkaloids 
also— jervme and veratroidine. The alkaloid jervine is found in both 
plants, is the same in chemical action and in physiological effects, and 
may, therefore, be considered identical. There are very close affinities 
between the veratralbine of Mitchell and the veratroidine first discov- 
ered by Bullock, but they are not the same ; they differ as respects 
their chemical relations, and also in physiological properties, veratral- 
bine being much more powerful than jervine and veratroidine. Vera- 
trum album and veratrum viride contain abundance of soft resin, 
which, when pure, is nearly, if not quite, inert. As the alkaloid jer- 
vine is with difficulty separated from the resin, it is probable that the 
physiological activity, ascribed to the resin by some observers, is really 
due to the presence of the alkaloid. 

Antagonists and Incompatibles. — The effects of veratrum viride 
on the heart are counterbalanced by alcoholic stimulants, opium, and 
ammonia. When dangerous symptoms are produced, the recumbent 
position should be enforced, alcoholic stimulants should be adminis- 
tered by the stomach and rectum, and dry heat should be applied to 
the body. Ammonia may also be given by the stomach or by intra- 
venous injection, and, if nausea and vomiting persist, morphine may be 
administered subcutaneously. The tincture of opium, in stimulant 
doses, may be prescribed with the alcoholic stimulants. 

Synergists. — The vaso-motor depressants — tobacco, lobelia, aco- 
nite, etc. — are synergistic. Blood-letting, haemorrhage, purgatives, 
and all agencies which diminish vital power, increase the effects of 
veratrum. 

Physiological Effects. — In the remarks which follow, veratrum 
viride only is referred to. 

Applied to the skin, veratrum viride excites redness and heat, and, 
to the Schneiderian mucous membrane, it causes violent sneezing. It 
is a prompt and efficient emetic, but its operation is accompanied with 
intense nausea and depression, and the vomiting is often violent and 
persistent. The contents of the stomach are at first evacuated, and 
afterward of the gall-bladder, so that it has been supposed to possess 
the power to increase the secretion of bile. It does not generally 
purge, but occasionally profuse watery evacuations have been produced 
by it, and rarely severe hypercatharsis. Its alkaloids enter the blood 
with facility. The power which veratrum viride has to affect the car- 
diac movements and the vascular tonus is its most characteristic prop- 
erty. It lowers, in a remarkable manner, the number and force of the 
cardiac pulsations. The pulse may be reduced to fifty, forty, or even 



604 MOTOR DEPRESSANTS. 

thirty-five per minute, and its force correspondingly diminished. Ac- 
cording to Linon, the arterial tension is raised, as shown by the sphyg- 
mograph. By very careful administration, this reduction in the pulse- 
rate may sometimes be accomplished without inducing nausea and 
vomiting, but usually vomiting can not be prevented when the remedy 
is pushed to this extent. When the pulse is reduced very decidedly, 
the patient being in the recumbent posture, a change to the erect posi- 
tion at once alters its character, and it becomes extremely rapid, 
thready, and feeble. 

Yery great depression of the powers of life is produced by large 
doses. The action of the heart becomes exceedingly weak, the pulse 
almost indistinguishable, the vomiting and retching extreme, the sur- 
face of the body cold and covered with a cold sweat, the temperature 
reduced. There are also produced faintness, dimness of sight, dilata- 
tion of the pupils, giddiness, great muscular weakness, shallow and 
slow respiration ; sometimes somnolence, coma, and insensibility, with 
stertorous breathing. Notwithstanding the very formidable symp- 
toms produced by large doses, fatal results have been extremely rare. 
An ounce of the tincture has been swallowed without causing death 
(Norwood). The prompt emesis which it produces is probably the 
explanation of its lethal inactivity ; for, in the act of vomiting, the 
medicine is ejected with the first matter from the stomach. Suspen- 
sion of the medicine and free stimulation quickly remove the most 
alarming symptoms of depression. 

The experimental investigations into the actions of jervine and 
veratroidine, made by Wood, Peugnet, and others, have shown that 
the physiological actions of veratrum viride are the sum of the ac- 
tions of the alkaloids. The nauseating and emetic qualities of the 
drug are due, chiefly, to veratroidine, and to a slight extent to the 
resin. Both alkaloids depress the functions of the spinal cord, and 
destroy its reflex activity ; but they do not impair the excitability of 
the nerves, nor the contractility of muscles. Veratroidine, according 
to Wood, first stimulates the inhibitory cardiac nerves to an extraor- 
dinary extent, and afterward paralyzes them ; but the evidence which 
he adduces in favor of the singular statements on this point are far 
from satisfactory. Both alkaloids lower the blood-pressure, by dimi- 
nution of vaso-motor tonus, and paralyze the cardiac muscle, and 
probably also its contained ganglia. They cause death by asphyxia — 
by paralysis of the muscles of respiration. The cerebral effects which 
have been noted in man, and the convulsions in animals, are doubtless 
due to the accumulation of carbonic acid in the blood. 

Theeapy. — The best preparation for administration is the tincture. 
As the therapeutic properties of veratrum viride depend, chiefly, on 
the jervine, an attempt may be made in the future to supply this alka- 
loid in sufficient quantity for administration ; but, at present, the pro- 



VERATRUM VIRIDE. 605 

cesses involved in its preparation are too intricate and expensive. As 
the effect of veratrum viride quickly reaches its maximum, if it be de- 
sired to maintain the pulse-rate at a constant level, the doses must not 
be at a longer interval than two hours. The effect must be main- 
tained by increasing doses, if necessary, and the recumbent posture 
must be rigidly enforced. 

The emetic property of veratrum viride is never applied in prac- 
tice ; too much depression is produced by it. The chief use of this 
agent is to depress the action of the heart and to lower the vaso-motor 
tonus. In simple hypertrophy of the heart, without valvular lesion, it 
diminishes the overaction and thus gives relief to the most distress- 
ing symptom. The irritable heart, so frequently found associated 
with and dependent on the excessive use of tobacco, on mental excite- 
ment and irascibility of disposition, and on overstrain, is relieved by 
this remedy, provided no valvular lesions coexist. The hypertrophy 
of the cardiac muscle, and the abnormal arterial tension, which ac- 
company the chronic form of albuminuria, are alleviated by veratrum 
viride. Moderate doses of the tincture (five drops ter die) usually 
suffice in these cases. When there are valvular lesions, and when 
the cardiac muscle is enfeebled from any cause, this agent is inad- 
missible. 

Excellent results are sometimes obtained in aneurism by the use of 
veratrum viride. In the various surgical expedients for the cure of 
aneurism (forced flexion, compression, ligation), this remedy, used to 
depress the circulation, renders an important service, by lessening the 
force with which the blood is propelled, and the number of the cardiac 
contractions. In this way, coagulation of the blood in the aneurismal 
sac is greatly favored. In the case of large internal aneurisms — of 
the innominata, aorta, etc. — veratrum viride is a powerful adjunct to 
rest and other means of treatment. Some precautions are necessary, 
however, in the administration of this remedy. As the utmost slow- 
ing of the circulation consistent with safety may be required, a suffi- 
cient quantity of the tincture must be administered to accomplish this 
object, and the effect produced is the only measure of the amount to 
be given. The result must be accomplished, if possible, without caus- 
ing vomiting. The patient should, therefore, remain absolutely in the 
recumbent posture, and a little opium should be prescribed with the 
veratrum viride. Active haemorrhage, occurring in the plethoric, is 
sometimes stopped by full medicinal doses of this drug. 

There can be no doubt that veratrum viride renders an important 
service in acute parenchymatous congestion — of the brain, lungs, liver, 
and other organs. Its utility ceases when exudations have taken 
place : its action is confined to the influence which it has in diminish- 
ing the blood-supply to the affected organs. The changes produced 
by inflammation are in no wise affected by veratrum viride. Much 



606 MOTOR DEPRESSANTS. 

that is extravagant has been written in regard to its curative influence 
in pneumonia, but we need not be surprised at this, when we reflect 
that our knowledge of the natural history of this disease is only of 
recent origin. Those who knew nothing of the period of crisis of 
pneumonia naturally attributed the defervescence of temperature to 
the effect of the remedy. It is not to be denied that in the very in- 
cipiency of pneumonia, before fibrinous exudation has taken place, 
veratrum viride, by lessening the amount of blood circulating in the 
lungs, may render an important service, but when hepatization occurs 
its good effects cease. The same observations are true of other pa- 
renchymatous inflammations, and equally so of serous inflammations. 

Veratrum viride has been much extolled as a remedy for reducing 
the pulse-rate and the temperature in typhoid and other fevers (Nor- 
wood). It is true, these effects may be procured by it, but that any 
influence is exerted in this way, over the course and duration of a 
fever, seems highly improbable. The chief dangers in fever being the 
occurrence of cerebral or cardiac paralysis due to the persistent eleva- 
tion of the temperature, it is unwise to use a powerful cardiac depres- 
sant, although it has the power to lower the temperature somewhat. 
There is, however, a condition of things arising in the course of fevers 
— viz., delirium ferox — in which, when dependent on arterial excite- 
ment, much good may be accomplished by the use of veratrum viride. 

The excitement of acute mania, of maniacal delirium, and other 
forms of mental disorder in which a condition of cerebral hyperemia 
may be supposed to exist, is successfully combated by veratrum viride. 
In a private communication, Dr. Sullivan, of San Francisco, informs 
me that this agent ( 3 ss of the fluid extract every fifteen minutes until 
nausea or vomiting ensues) is "invaluable in puerperal convulsions" 
Barker, in his " Puerperal Diseases," had already called attention to 
its utility, and Boyd confirms the previous observations. It well de- 
serves trial in this malady and in analogous states. 

Veratrine is used only externally, and for the relief of neuralgia, 
headache, myalgia, etc. The official unguentum veratrim is the form 
in which it is employed — a small quantity being rubbed in over the 
seat of pain. 

Authorities referred to : 

Boyd, Dr. American Practitioner, January, 1878. 

Briesemann, C. Mikroskopische Untersuchungen uber die Wirkung des Digitalin, 
Vcratrin u. Ergoiin auf die Cirkulation, Rostock, 1869. 

Linon, M. Gazette Medicate de Strasbourg. Bulletin General de Therapeutique, vol. 
Lxxvi, p. 94. 

Mitchell, Charles L. Transactions of American Pharmaceutical Association, vol. 
xxii, p. 397. The Active Principles of the Officinal Veratrums. 

Norwood, Dr. W. C. The Authorship and Therapeutical Powers of Veratrum Viride 
more fully examined, Albany, 1868, p. 39. 



PULSATILLA. 607 

Oulmont, M. Bulletin General de Tlierapeutique, vol. lxxiv, p. 153. 
Ibid. Communication of paper by MM. Zuber and Hirtz to Society of Therapeutics, 
Bulletin General, vol. lxxvi, p. 468, et seq. 

Percy Dr. S. R. Transactions of American Medical Association, 1864. 

Peugnet, Dr. Eugene. The Medical Record, May, 1872. 

Squarey, Dr. The Practitioner, 1870, vol. i, p. 211. 

Wood, Dr. H. C. The American Journal of the Medical Sciences, January, 1870. 

Pulsatilla. — Pasque-flower. The herb of Anemone Pulsatilla and 
Anemone pratensis Linne, and of Anemone patens Linne, var. Nxittal- 
liana Gray (Nat. Ord. Banunculaceai), collected soon after flowering. 
(U. S. P.) Pulsatille, Fr. ; Kuchenschelle, Ger. 

Peepaeatioxs. — There are no official preparations. The tincture 
is the form usually employed in medical practice, the dose of which 
varies from one minim to twenty minims. 

Composition. — The peculiar powers of the plant depend on the 
presence in it of an alkaloid — anemonme i a camphor. Anemonine 
crystallizes in prisms — the regular rhombic system — and is hardly at 
all soluble in cold water and in alcohol (Husemann). Pulsatilla also 
contains a peculiar acid — anemonic acid. 

Antagonists and Ixcompatibles. — The caustic alkalies, tannic 
acid, and the metallic salts generally, are chemically incompatible. 
From the physiological standpoint, pulsatilla is antagonized by the 
alcohols, by opium, digitalis, etc. 

Stxeegists. — The effects of pulsatilla are promoted by the para- 
lyzers, especially by the other members of the same family — notably, 
by aconite, veratrum viride, etc. 

Physiological Actions. — The local effects of pulsatilla (the fresh 
plant) are those of an irritant ; and, after prolonged contact, even 
caustic effects are produced. Applied to the tongue, it gives rise to 
tingling, burning, followed by numbness — effects very similar to those 
caused by aconite. On the intestinal mucous membrane it has very 
pronounced irritating effects. The active principles diffuse into the 
blood with facility. Depression of the heart's action, lowering of the 
arterial tension, and declination of temperature, are caused by pulsa- 
tilla. It is a paralyzer of motility and sensibility, but, as respects the 
motor functions, it is not known whether it impairs the contractility 
of muscle or the irritability of nerve ; and, as respects sensation, it has 
not yet been determined whether the lessened sensibility is due to an 
influence which this remedy has on the spinal cord, on the nerve- 
trunks, or on the peripheral expansion — end-organs of the sensory sys- 
tem. Dilated pupils, hebetude of mind, stupor, coma, and convulsions, 
are cerebral symptoms which occur after a lethal dose has been ad- 
ministered. These cerebral effects may be due to a primary action of 
pulsatilla on the brain, or to the carbonic-acid poisoning and the anae- 
mia. When the action of the heart and the respiration are very feeble, 



608 MOTOR DEPRESSANTS. 

carbonic acid accumulates in the blood, and an extreme degree of cere- 
bral anaemia ensues. Coma, convulsions, and insensibility, are natural 
effects of these causes. Nothing is positively known as to the time 
and mode of elimination of anemonine, but it is probable that excre- 
tion takes place by the kidneys. 

The production of any given physiological effect will, of course, 
depend on the genuineness of the drug. The active principles are 
volatile, and often disappear in the process of desiccation. 

Therapy. — Owing to the irritating action of pulsatilla, it is not 
suited to the treatment of gastro-intestinal disorders, especially when 
a state of inflammation exists. Notwithstanding this local irritant 
effect, homoeopathists employ it for the relief of dyspepsia and the 
accompanying mental symptoms ; but, in coming to conclusions as to 
its curative value, they calmly ignore the natural history of these 
maladies. 

Pulsatilla is adapted to the treatment of acute inflammation of the 
nasal, faucial, laryngeal, and bronchial mucous membrane — acute 
catarrh. It is not proper in those cases when accompanied by gastro- 
intestinal disturbance. It is clearly useful in acute inflammation of 
the cerebral and spinal meninges. 

It is used by the homoeopathists in the treatment of catarrhal oph- 
thalmia, by internal and local applications ; and they hold that it is 
very efficacious in certain diseases of the uterus, on which organ they 
suppose it to have a special or specific action. Sudden arrest of the 
menstrual floio, whether caused by moral emotion or by cold, may be 
relieved, and the effects prevented, by pulsatilla. As aconite is very 
useful under the same circumstances, it may be assumed that good 
results may be had by the administration of pulsatilla. 

Authorities referred to : 

Gtjbler, Prof. A. Codex Medicamentarhis, p. 1Y. 
IIusemann, Drs. Aug. und Theod. Die Pflanzenstofe, p. 795. 
Phillips, Dr. Charles D. F. Materia Medica and Therapeutics, p. 17. 

Grindelia. — The leaves, stems, and flowers of Grindelia robusta 
Nuttall (Nat. Ord. Composite). (IT. S. P.) 

Preparations. — Extractum Grindelia} Fluidum. — Fluid extract 
of grindelia. Dose, tt[ x — 3 j. 

Extractum Grindelioe. — Extract of grindelia. (Not official.) Dose, 

gr. j— gr. v. 

Composition. — An alkaloid with basic properties has been isolated 
(Rademaker), but its chemical relations have not been fully made out. 
The plant contains also a volatile oil, and a resin, to which its physio- 
logical activity is doubtless in part due. 

Antagonists and Incompatibles. — Water precipitates the oleo- 
resin. The mineral salts and caustic alkalies are chemically incom- 



' GRINDELIA. 609 

patible. Opium, the cerebral stimulants, alcohol, strychnine, picrotoxin, 
etc., are opposed as respects the physiological actions. 

Synergists. — All motor depressants increase the actions of grin- 
delia. 

Physiological Actions. — The taste of grindelia is rather pungent, 
even acrid, and in the stomach it excites a sensation of warmth. The 
local stimulant effect is such that it promotes the appetite and diges- 
tion ; but, if too long continued, or in too great quantity, it excites 
gastric uneasiness. Grindelia slows, somewhat, the heart and respira- 
tory movements. When administered in sufficient quantity, decided 
cerebral effects are produced. It dilates the pupil and induces sleep. 
During this condition of hypnotism, the general cutaneous sensibility 
is much reduced, and reflex movements become sluggish. Motility is 
also affected, the paresis beginning in the hind extremities. Its toxic 
powers are by no means great, two drachms of the fluid extract be- 
ing required to induce sleep in small rabbits. It affects other warm- 
blooded animals, and also frogs, in the same way. When death 
ensues, it is from paralysis of the muscles of respiration. Elimina- 
tion takes place by the pulmonary mucous membrane, and chiefly by 
the kidneys. 

Therapy. — The most important uses of grindelia, thus far devel- 
oped, are in the treatment of the respiratory neuroses. Its utility in 
the treatment of asthma, especially the so-called spasmodic asthma, is 
certainly great ; few cases fail to be relieved at once. Besides the 
stomach administration, it may be given in the form of fumes, accord- 
ing to the following plan : The plant is steeped in a saturated solu- 
tion of nitre, dried, when it may be ignited on an ordinary tin plate, 
the patient inhaling the fumes as they arise, or the fumes in the air of 
a small, closed apartment. This preparation may also be rolled into 
cigarettes, and smoked with or without the addition of tobacco, stra- 
monium, lobelia, etc. The fluid extract of grindelia may be incorpo- 
rated with other asthmatic remedies, in an extemporaneous prescrip- 
tion. For example : ^ Ext. grindeliae fluid., 3 ss ; ext. lobelia? fl., 
3 ij ; ext. belladonna? fl., 3 j ; potassii iodidi, 3 iij ; glycerini, f iij. 
M. Sig. : A tablespoonful, as necessary. 

Cough by imitation and habit, whooping-cough, and the spasmodic 
difficulty of breathing which accompanies various pulmonary and car- 
diac diseases, hay-asthma, etc., are helped by grindelia. It is also an 
effective remedy for bronchitis, after the subsidence of acute symp- 
toms ; for chronic bronchitis and bronchorrhoea, and for the bronchitis 
of emphysema. 

Besides the above diseases for which grindelia has been used with 
success, it will prove advantageous in chronic pyelitis, chronic cystitis, 
etc. In these diseases local application of the oleo-resin takes place 
all along the urinary tract. 

39 



610 MOTOR DEPRESSANTS. 

Authorities referred to : 

Crowe, Dr. John E. Louisville Medical News, April, 1876. 
Fiske, Dr. H. M. The Pacific Medical and Surgical Journal. 
Rademaker, Dr. C. J. Louisville Medical News. 

Phytolacca. — Phytolacca bacca. — The fruit of Phytolacca decandra 
Linne (Nat. Ord. Phytolaccacece). (IT. S. P.) Poke-berries. 

Phytolacca^ radix. — The root of Phytolacca decandra — poke-root. 

Preparations. — PJxtractum Phytolacca} Fluidum. — Fluid extract 
of phytolacca. Dose, tti v — 3 j. (Not official.) 

Tinctura Phytolacca?. — Tincture of phytolacca. Dose, t\[ x — 3 j. 
(Not official.) 

Composition. — Claussen has obtained a neutral principle, which he 
has named phytolaccin, but this should not be confounded with an 
impure resin called by the eclectics "phytolaccin." Claussen's phyto- 
laccin occurs in silky, shining crystals, soluble in alcohol and ether, 
but not in water. A peculiar acid, phytolaccic acid, has also been 
found in the berries by Terail. It is uncrystallizable, but soluble in 
water and in alcohol. 

Antagonists and Incompatibles. — Alcohol, ether, opium, digitalis, 
etc., oppose the action of phytolacca. 

Synergists. — All depressing agents, the paralyzers, and emetics, 
contribute to the effects of phytolacca. 

Physiological Actions. — Poke is nauseant and emetic, and these 
effects occur, whatever may be the mode of administration. The emesis 
does not occur at once ; there is a slowly-accumulating anguish ; vomit- 
ing does not result for an hour, and the vomiting is accompanied with 
great depression. Rutherford has shown that the eclectic preparation 
phytolaccin has decided cholagogue property — ranking, indeed, among 
the most effective of the agents influencing the flow of bile. 

Phytolacca lowers the rate of cardiac movement and the respiration, 
but does not alter the rhythm. It is a paralyzer, the loss of power 
occurring first in the hind extremities. The impairment of motility is 
not due to an action of this agent on the motor nerve or on the muscle 
— for the irritability of the nerve and the contractility of muscle remain 
unaffected when a lethal dose of phytolacca has been given. The action 
is on the spinal cord, chiefly on the medulla. In rabbits, violent trem- 
bling occurs, and convulsions, partly tonic, partly clonic, are produced. 
Death ensues from paralysis of respiration ; for in frogs, when all signs 
of life have ceased, the heart is found to be in action, on opening the 
chest. In cases of accidental poisoning, convulsions of a tetanic char- 
acter have been observed. Elimination takes place chiefly by the 
kidneys. 

Therapy. — Poke has been proposed as an emetic, but the slowness 
of the action, and the great depression of the powers of life which it 



AILANTHUS. 611 

causes, have prevented, and will ever prevent, its employment for this 
purpose. 

Alterative powers have been ascribed to it, and cases supposed to 
be malignant have been cured ; but these results were probably in- 
stances of the post rather than the propter hoc. Ulcers, cutaneous dis- 
eases, and ophthalmia, are maladies which have been reported cured. 
Fenner reported a case of granular conjunctivitis cured by it, and in 
the same issue of the journal there is an editorial note, affirming the 
remarkable powers of the remedy in this disease. If it really does 
cure this disease when given by the stomach, poke is a remedy of ex- 
traordinary value. The evidence is strong that phytolacca does pos- 
sess considerable power to promote the healing of varicose and other 
ulcers of the leg (Tidd). A soft extract is spread on muslin, and kept 
applied to the surface of the ulcer. Obstinate eczema has been cured 
in the same way. The pain and inflammation of burns may be as- 
suaged by the same application, and the healing greatly facilitated. 
How far the effect is merely mechanical does not appear. 

It has long been known that phytolacca is a serviceable remedy in 
chronic rheumatism. But the therapeutical application of this remedy 
most deserving of consideration is the treatment of inflamed breasts. 
There seems to be no reason to doubt that phytolacca possesses the 
remarkable property of arresting an inflammation of the mamma, and 
preventing suppuration. For this purpose the fluid extract may be 
given internally, and the solid extract spread on a cloth and kept 
applied to the breast which is the seat of the inflammation. The pos- 
session of this property to prevent suppuration in the breast implies 
the existence of the same property in threatened suppuration in other 
glandular organs. As the fact is entirely empirical, and rests on no 
physiological action of the drug, it can only be determined by further 
trials whether it will check suppuration elsewhere. 

Authorities referred to : 

Biggers, Dr. G. W. The American Journal of the Medical Sciences, vol. Ixv, p. 275. 
Dutcher, Dr. A. P. The Cincinnati Lancet and Observer, June, 1859. 
Tidd, Dr. C. H. The Clinic, vol. v, p. 253. 

Ailauthus. — The bark of A. glandulosa, a well-known and abundant 
shade-tree. (Unofficial.) 

Preparations. — Fluid extract. Dose, ttl x to 3 j. Bark, gr. x — 
3j. 

Composition. — The most important constituent is the oleo-resin. 
It contains, also, a volatile oil, which is extremely diffusible and pow- 
erful, and a bitter principle. 

Actions and Uses. — The taste is bitter and somewhat acrid. It is 
strongly nauseant, and the nausea is accompanied with weakness, ver- 
tigo, and cold sweating. It possesses decided purgative property, the 



612 MOTOR DEPRESSANTS. 

stools being large and watery. It has considerable power as a vermi- 
fuge, and is effective when employed against taenia. The action of the 
heart is at first increased, but is subsequently slowed, the pulse becom- 
ing small and weak. Respiration is similarly affected, and death en- 
sues in animals by paralysis of the muscles of respiration. 

On the brain and nervous system ailanthus acts as a paralyzer, the 
loss of power beginning in the hind extremities. The paralyzing ac- 
tion seems to depend on the volatile oil, while the purgative and an- 
thelmintic effects are possessed by the oleo-resin. 

Therapy. — The most important application of ailanthus is in the 
treatment of tape-worm. For this purpose the oleo-resin, or, better, a 
decoction of the fresh bark ( 3 j — 5 iv), may be used. The oleo-resin 
has the advantage in being a permanent preparation, whereas the bark 
loses its strength in the process of drying. 

Muscarine. — The alkaloid of Amanita muscaria, the fly-fungus. 

Properties. — Muscarine is an alkaloid with strong basic properties, 
and combines with acids to form salts. It has the consistence of sirup, 
is without odor, free from taste, and is readily soluble in water and in 
alcohol, but is insoluble in ether and in chloroform. Besides being 
obtained from the fungus, it has been constructed synthetically, the 
product having the same actions, it is alleged ; but this statement seems 
doubtful, especially in view of the rather negative results reached by 
Ringer, with a specimen furnished by Merck, of Darmstadt. 

As muscarine is but slightly irritating to the tissues, it may be 
used subcutaneously. The dose ranges from one eighth of a grain to 
two grains. According to Ringer, one third of a grain is the mini- 
mum quantity to produce symptoms in men, administered hypoder- 
matically, but in this statement he referred to Merck's alkaloid pre- 
pared synthetically. 

Antagonists. — The actions of muscarine are antagonized by atro- 
pine (Schmiedeberg and Koppe), by digitaline (Bohin), and by eserine 
(Prevost). By atropine it is antagonized at all points. When the 
heart is arrested by muscarine, it possesses the capability of again re- 
newing its action under the influence of a large number of agents, but 
atropine possesses this property in the highest degree (Alison). Mus- 
carine .arrests the heart in diastole by stimulating the intracardiac in- 
hibition apparatus — atropine paralyzes this apparatus (Prevost) ; mus- 
carine causes intense dyspnoea by inducing strong contraction of the 
pulmonary arteries — atropine relaxes this spasm, unloads the right cavi- 
ties of the heart, and respiration is resumed ; muscarine lowers, atro- 
pine raises the blood-pressure ; muscarine tetanizes the muscular layer 
of the intestine — atropine induces a paresis of the same ; muscarine in- 
creases the secretions of liver, pancreas, and intestinal mucous mem- 
brane — atropine arrests these secretions ; muscarine stops the renal 



MUSCARINE. 613 

secretion — atropine restores it ; muscarine causes sweating, salivation, 
and lachrymation — atropine dries them all ; muscarine contracts the 
pupil — atropine dilates the pupil. For the quantity producing a given 
physiological effect, the power of the two agents is very unequal, 
atropine being much stronger. An atropinized eye dilated to a cer- 
tain point will not be contracted by the quantity of muscarine suffi- 
cient when unopposed to induce a marked degree of myosis ; but a 
much larger quantity may overcome the atropine. The same fact is 
true throughout the whole range of their antagonistic action. 

In frogs poisoned by digitaline, the cardiac movements recommence 
and are maintained for hours by the application of a solution of mus- 
carine. The same fact is true of tobacco and physostigma : the heart 
arrested by these agents recommences movements when muscarine is 
applied, and vice versa. 

Synergists. — The motor depressants synergize some of the actions 
of muscarine. A close correspondence exists between pilocarpine and 
muscarine. They both cause nausea, diarrhoea ; muscarine at first 
quickens then slows, and pilocarpine quickens the pulse ; they both 
flush the face and produce free perspiration and salivation ; they both 
cause frontal headache ; both contract the pupil ; and both diminish 
the urinary secretion. They differ in some respects, but chiefly in the 
extent of their action, or quantitatively. Pilocarpine causes more 
perspiration and salivation ; muscarine produces decidedly more active 
intestinal movements. Pilocarpine diminishes the urinary secretion, 
but muscarine may arrest it entirely. Pilocarpine slightly contracts 
the pupil ; muscarine contracts the pupil more decidedly, but when 
applied to the eye directly, dilates the pupil. Pilocarpine always 
quickens the pulse, muscarine slows the pulse. 

Physiological Actions. — The salivary secretion in a large pro- 
portion of subjects is much increased. A feeling of constriction of 
the neck, nausea, and vomiting, and more or less abdominal pain, are 
produced by it, whether administered by the stomach or subcutane- 
ously (Brunton). The pancreatic and biliary secretions are notably in- 
creased after the injection of some milligrammes into a vein (Prevost). 
This increase of these secretions took place as well between as during 
digestion. The intestinal mucus is also greater in quantity than nor- 
mal, and it may be streaked with blood (Schiff). The intestines are 
thrown into active contractions, tetanized, rather than merely stimu- 
lated into more frequent vermicular movements. Under ordinary 
medicinal doses in man, the bowels are relaxed and the character of 
the evacuations altered, doubtless, because of the much greater quan- 
tity of the biliary and pancreatic secretions poured out. The increased 
movement of the intestines is accompanied by considerable colic-like 
pain. 

Muscarine enters the blood promptly, whether introduced through 



614 MOTOR DEPRESSANTS. 

the stomach or subcutaneously. It is a cardiac poison. A very mi- 
nute quantity — a mere trace — applied to the frog's heart, arrests its 
movements. As Schmiedeberg and Koppe first demonstrated, it ar- 
rests the heart in the diastole, and does not impair the irritability of 
the heart-muscle, for, on irritation of the heart by mechanical, chemi- 
cal, or electrical means, it again contracts. If the dose is short of 
lethal, the heart is merely slowed, the number of pulsations being- 
reduced ten, twenty, or even forty beats per minute. Section of the 
vagi does not affect this result. The action is due to stimulation of 
the intracardiac inhibitory apparatus. By Alison it is referred to over- 
excitation of the cardiac terminals of the vagus, and coincident dimi- 
nution in the activity of the sympathetic fibers. When the effects of 
muscarine are manifested by a diminution of the pulse-rate, the blood- 
pressure begins to decline. At first the vessels contract, but this is 
soon succeeded by dilatation (Bogosslowsky). With the slowing of 
the heart and dilatation of the vessels, the blood accumulates in the 
periphery, and the blood-pressure is consequently reduced one half. 

Disturbances of respiration occur with the other defined symptoms. 
The breathing grows more labored with the increasing effects of the 
agent, and presently an intense dyspnoea supervenes (Schmiedeberg). 
The mechanism of the labored respiration is obvious enough. Such a 
strong contraction of the pulmonary vessels ensues as to greatly di- 
minish the quantity of blood circulating in the lungs, with the result 
of over-distention of the right cavities of the heart. Hence it follows 
that the state of the blood is impaired by the lack of oxygen and the 
retention of carbonic acid, and to these factors must be attributed in 
part the cyanosis and asphyxia. These modifications of the respiration 
occur after preliminary section of the vagi. The almost arrested oxy- 
genation of the blood, the languid circulation, and the profuse perspi- 
ration, are the factors which cause a lowering of the temperature. By 
Schmiedeberg and Koppe there are recognized three conditions of the 
body-heat : 1. A slight elevation, which is by no means constant, and 
very transient, coming on in about two hours after the dose — a small 
one — has been taken ; 2. A depression of one or two degrees, suc- 
ceeded presently by the normal temperature, produced by a full medi- 
cinal dose ; and, 3. A very pronounced lowering of the temperature 
from a fatal dose. 

By the internal administration of muscarine the pupil contracts, and, 
singularly enough, by direct application, dilates. There are other ex- 
amples of this paradox. Vision is disturbed by alteration of the ac- 
commodation apparatus by spasm. The myosis depends on stimulation 
of the circular fibers of the iris or of the third nerve, and not on paral- 
ysis of the radiating fibers, or of the sympathetic filaments. 

Muscarine produces abundant perspiration, and, indeed, stimulates 
this function only less powerfully than pilocarpine. In most cases the 



MUSCARINE. 615 

saliva is correspondingly increased. The two functions do not always 
act together with the maximum energy, and one may be powerfully 
affected, while the other is quiescent. Lachrymation is nearly con- 
stant, and the nasal mucus is more abundant than in the normal state. 
Thus, while all other secretions and excretions are increased by mus- 
carine, it is remarkable that the urine should be decidedly lessened in 
amount, even suppressed. In eight experiments made with great care, 
Prevost found that the injection of muscarine into a vein diminished 
the urinary secretion, and, indeed, almost stopped it when the dose 
was large. The elimination of muscarine takes place by the kidneys. 
The best evidence that it is excreted unchanged is the physiological 
action of the urine. The urinary secretion of an animal poisoned by 
muscarine will poison another animal to whom it is administered, and 
its powers are transmitted with little diminution through several. 

Therapy. — The applications of muscarine to the treatment of dis- 
ease are yet in their infancy. The physiological effects indicate the 
direction of the remedial applications. As muscarine stimulates so 
powerfully the muscular fiber of the intestine, and the secretions of 
the pancreas, liver, and intestinal mucous membrane, it ought to be 
very serviceable in cases of constipation with torpor of the organs 
concerned in digestion. When constipation is due to paresis of the 
muscular layer of the bowel and to deficient secretion, this remedy 
will probably relieve it. In the treatment of intestinal torpor and de- 
ficient secretion, muscarine may be combined with other remedies, as 
atropine and strychnine, which act on the organs concerned, or with 
cathartics and cholagogues : $ Muscarine, gr. iv ; ext. belladonnge, 
ext. nucis vomicae, aa gr. iij ; euonymin, 3 ss. M. Ft. pil. no. xij. 
Sig. : One pill morning and evening. When the digestion of the 
starches and fats is imperfect, it is strongly indicated. In catarrh of 
the duodenum, and in catarrhal jaundice, it ought to be very efficient. 
In these maladies, the remedy should be administered frequently and 
in small doses : fy Muscarine, gr. j ; aquae, f j. M. Sig. : A tea- 
spoonful every three hours. It is probable, also, that it will prove 
useful in recent hemorrhoids due to congestion of the portal circulation. 
It promises well as a remedy for the removal of inflammatory effusions 
and exudations. It ought to afford prompt relief at the onset of a 
common cold, an acute bronchitis, hay-asthma, etc. As muscarine pro- 
duces strong contraction of the pulmonary capillaries, it ought to be 
useful in pulmonary haemorrhage, in incipient congestion of the lungs, 
etc. Under such circumstances the combination with digitalis ought 
to be especially effective, for, while digitalis will aid the curative ac- 
tion on the pulmonary vessels, it will, at the same time, antagonize 
the cardiac depression caused by muscarine. It is contraindicated in 
affections of the air-passages when secretion is in excess. For the 
night-sweats of phthisis fly-fungus has long been used, and a similar 



616 MOTOR DEPRESSANTS. 

fungus is commended by Trousseau ; but it has not been as success- 
ful in the hands of Murrell as some other agents, although capable, 
sometimes, of very good results. Muscarine is of doubtful propriety, 
if not positively contraindicated, in renal affections characterized by 
deficiency in the excretion. On the other hand, it ought to be of sig- 
nal service in diabetes insipidus and in saccharine diabetes. It has 
been used successfully to arrest the secretion of milk. 

Authorities referred to : 

Alison, Dr. Bouchardafs Annuaire de Therapeutique, etc., for 1877, p. 47 ; also, Gaz. 
Med. de Paris, February 20, 1877. The Action of Atropine and Muscarine on the Heart. 

Bogosslowsky, Dr. Centralblatt fur die med. Wissenschaften, No. 97, 1870. 

Brttnton, T. Lauder. Journal of Anatomy and Physiology, 1876, p. 342. 

Harnack, Dr. Erich. Archiv fur experimentelle Pathol, und Pharmakol., Band iv, 
p. 168. Untersuchungen uber PJlegenpilzalkaloide. 

Prevost, Dr. J. L. Bull. Gen. de Therap., vol. xciii, p. 371. Note relative d VAn- 
iagonisme mutucl de V Atropine et de la Muscarine. 

Ringer and Mosshead. Ringer's Hand-Book of Therapeutics, eighth edition, article 
Muscarine. 

Schiff, Prof. Lo Sperimentale, abstracted in the London Medical Record, vol. iv, 
1876, p. 339. 

Schmiedeberg und Koppe. Das Muscarin, das giftige Alkaloid des Fliegenpilzes, etc. 
Leipsic, 1869. Yogel. 

Quebracho. — The bark of Aspidosperma quebracho, an apocynaceous 
tree of Chili. 

Preparations. — Tincture. — One part of quebracho to five parts of 
alcohol. Dose, TH, v — 3 j. 

Wine. — One part of quebracho, two parts of alcohol, and sixteen 
parts of white wine. Dose, a teaspoonf ul to a tablespoonful. A fluid 
extract, prepared according to the general directions of the Pharma- 
copoeia, will probably be found an eligible preparation. 

Composition. — Quebracho seems peculiarly rich in alkaloids, but 
it is doubtful whether any one represents in its entirety the physio- 
logical powers of the bark itself. The most important are aspido- 
spermine, discovered by Fraude in 1878, and quebrachine, separated 
by Hesse in the following year. Hesse describes several other active 
constituents or alkaloids, but the two just mentioned are the most 
important. 

Adulterations. — Soon after the first specimens were sent to 
Europe, the sudden demand which sprang up induced sophistication, 
and quebracho-wood and quebracho Colorado were substituted for the 
genuine. This substitution proved the less important, since these 
preparations acted in a similar manner, and were only weaker (Pen- 
zoldt). The early physiological investigations must, therefore, be in- 
terpreted by the light of this difference in the action of the several 
substances comprehended in the term quebracho. 



QUEBRACHO. 617 

Physiological Actions. — Quebracho has the stomachal effects of 
the bitters in general : it promotes appetite and increases the diges- 
tive powers. The alkaloids diffuse promptly into the blood. The 
action of the heart is lowered ; the pulse in the normal state is less 
frequent ; at first, the tone of the artery is higher and the blood-press- 
ure is raised, but as the action is continued, especially from lethal 
doses in animals, the force of the circulation declines and the pressure 
falls. The respiration is also slowed, and the sense of need of air is 
less imperative. The hurry of circulation and of respiration, and the 
feeling of oppression induced by active exercise, are modified by 
quebracho. Picot-Berthold studied these actions on his own person. 
Ascertaining first the rate of increase of the respiratory movements and 
of the circulation induced by active exercise of a definite amount, he 
next determined the influence of the remedy on these functions when 
the same amount of exercise had been taken. While without quebra- 
cho his pulse and respiration rose respectively to 42 and 94, under the 
action of the medicament they were 30 and 80. Not only was the 
rate of movement lessened, but the accompanying distress for want 
of air was decidedly ameliorated. 

Guttmann, who has made an elaborate study of aspidospermine, finds 
that in both cold- and warm-blooded animals it is an active poison 
of the respiratory and circulatory apparatus. In cold-blooded animals 
the respiratory actions are most pronounced, and death is produced 
by the effect of the poison on the respiratory center. Slowing of the 
heart's action proceeds pari passu with the diminution of the respira- 
tory energy, and the cessation of the heart's movements is finally due 
to the impression of the poison on the intra-cardiac motor ganglia. 
In warm-blooded animals (cats) the influence of the poison on the 
heart is primary. The slowing of the pulse is not due to any effect 
which it has on the vagi, but to the paralyzing action which it exerts 
on the cardiac motor ganglia. With, the slowing of the heart the 
temperature declines, and, with the diminution of respiration, dyspnoea 
comes on. Then the accumulation of carbonic acid in the blood in- 
duces stupor, and in animals convulsions. The reflex function is low- 
ered in cold- but not in warm-blooded animals ; sensibility is unaf- 
fected in the latter, but motor paralysis finally occurs in both classes. 
Death is due to paralysis of the heart. 

Therapy. — The applications of quebracho in the treatment of dis- 
ease were originally empirical, but they are clearly deducible from its 
physiological actions. It has long been known as a fever-medicine 
and as a remedy for dyspnoea, in the province of Santiago, Chili, 
where it was first obtained by Dr. Schickendanz. It has been used 
as a stomachic tonic, like the bitters in general, but more especially 
like cinchona, to increase the appetite and digestion in atonic dys- 
pepsia. It is, however, chiefly important as a remedy for dyspnoea. 



618 MOTOR DEPRESSANTS. 

Picot, Skoda, Krauth, Penzoldt, and many others, have used it in va- 
rious instances of difficult breathing, with remarkable palliation. In 
emphysema, spasmodic asthma, urwmic asthma, in spasmodic cough, 
chronic bronchitis, with asthmatic breathing, it has afforded very con- 
siderable relief. It has appeared to be much less useful, if not injuri- 
ous, in the dyspnoea from valvular disease of the heart, and has had no 
effect in the dyspnoea of old subjects due to atheroma of the vessels. 
Krauth, however, has used it with advantage in the dyspnoea due to 
hypertrophy of the heart and in the difficulty of breathing in a case of 
albuminuria consecutive to scarlatina. The relief to dyspnoea in all 
cases, Penzoldt thinks, is referable to the increased consumption of 
oxygen by the blood, but a more rational explanation would seem to 
be the action on the respiratory center, and the diminution in the 
sense of need of air. 

Having a paralyzing action on the cardiac motor ganglia, quebracho 
is not without danger in cases of weak heart. It must be considered a 
doubtful remedy when the motor apparatus of the heart is impaired — 
especially, if the accelerator nerves and their terminal ganglia are the 
parts damaged. On the other hand, when the lesions of the heart are 
merely valvular, it would appear to be safe ; but in the dyspnoea due 
to this cause it is much less useful (Laquer, Berger). Certain unpleas- 
ant results of its administration render prolonged use of quebracho very 
difficult. These are, according to Laquer, headache, dullness of the 
sense-organs, vertigo, salivation, and a strong repugnance to its taste. 

The preparation most used at present is the extract, and the usual 
dose for an adult is five grains. The alkaloid aspidospermine has been 
administered chiefly in the experimental way, but, although its actions 
correspond closely to those of the bark itself, it can hardly represent 
the drug in its entirety, seeing that there are several alkaloids con- 
tained in it. The salts of aspidospermine — the citrate, hydrochlorate, 
and sulphate — are freely soluble in water, while the alkaloid itself is 
not at all readily soluble in water, but is taken up freely by oils and 
fats — five to eight parts dissolving in one hundred parts of cod-liver 
oil by heat. 

Authorities referred to : 

Berger, M. Pharm. Journ. and Trans., quoted by Annuaire de Therapeutique for 
1881. 

Fraude, M. G. Quebracho-Aspidospermine. Bull, de la Soc. de Chim. } quoted by An- 
nuaire de Therapeutique for 1881. 

Gutthann, Dr. G. Ueber Wirkung und Anwendung verschiedener Aspidosperminpra- 
parate. Archiv fur experiment. Pathologie und Pharmakologie, Band xiv, p. 463. 

Krauth, Dr. Ecorce de Quebracho, son emploi therapeutique. Bull. Gen. de TJierapeu- 
tique, 1880. 

Penzoldt, Dr. F. Die WirTcungen Quebrachodogen, Erlangen, 1881. (Pamphlet.) 

Picot-Berthold. Quoted in Annuaire de Therapeutique for 1881. 

Skoda, Prof. Dr. Wiener med. Blatter, No. 41, 1879. 



EMETICS. 619 

REMEDIES USED TO CAUSE SOME EVACUATION 
FROM THE BODY.—EVACUANTS. 

EMETICS. 

Some of the agents in this group produce vomiting by virtue of a 
local action on the stomach, and do not affect this viscus when intro- 
duced elsewhere. These may be entitled Emetics by Local Action. 
There are others which cause emesis when they enter the blood at any 
point — Systemic Emetics. The first sub-group of emetics make an im- 
pression on the gastric nerves, and an action is at once instituted for 
their expulsion. The process consists in the transmission of the periph- 
eral irritation to the spinal center, the generation of a motor impulse, 
and the consequent action of the nervous and muscular apparatus 
concerned in the mechanism of vomiting. The systemic emetics pro- 
duce their effects through the intermediation of the blood, and the vom- 
iting is only one of the results of the disturbance introduced into the 
functions of the nervous system. 

EMETICS BY LOCAL ACTION. 

The most important of these are : 

Cupri sulphas, sulphate of copper. 

Zinci sulphas, sulphate of zinc. 

Hydrargyri sulphas flav a, yellow subsulphate of mercury. 

Alumen, alum. 

Sinapis, mustard. 

Scilla, squill. 

All of the members of this group have been discussed in other parts 
of this work, except mustard and squill, and the consideration of these 
will be more appropriate elsewhere. It is necessary, however, in this 
place to indicate the nature of the action, the cases to which they are 
adapted, and the mode of administration of the more important of the 
emetics belonging to this division. 

Cupri Sulphas. — This is a very prompt and efficient emetic. The 
action begins in a few minutes, and the medicine comes up with the 
vomited matters. Very little depression follows the emetic action. It 
is more especially adapted to the treatment of narcotic poisoning ', be- 
cause, the action being local, the obtunded state of the reflex centers 
interferes less with its operation than is the case with the systemic 
emetics ; and to phosphorus p>oisoning -, because of its antidotal power. 
It is also occasionally used in croup, to effect the dislodgment of the 
false membrane, but other mechanical emetics are preferable. 

Admlnisteation. — Dissolve twenty grains of the sulphate of copper 
in two ounces of distilled water, and give a tablespoonf ul every fifteen 



620 EYACUANTS. 

minutes until vomiting occurs. When prompt action is required, as in 
narcotic poisoning, ten grains of the sulphate of copper may be given 
at a draught in an ounce or two of water. Its action should be assisted 
by the free use of diluents. 

Zinci Sulphas. — This agent acts in a manner similar to the corre- 
sponding copper-salt, but is less powerful. It has the advantage of be- 
ing less likely to induce gastro-enteritis than sulphate of copper, and 
is, therefore, usually preferred to the latter. It is administered in cases 
of narcotic poisoning, in croup, and to relieve the stomach of indi- 
gestible alimentary substatices. 

Administration. — In narcotic poisoning a scruple of the sulphate 
of zinc may be administered in water, and, if need be, repeated once. 
In croup, or for other purposes, as an emetic, it may be given as fol- 
lows : Dissolve a half-drachm in two ounces of water, and administer a 
tablespoonf ul every fifteen minutes until emesis is produced. The free 
use of diluents promotes the emetic action. 

Hydrargyri Sulphas Flava. — This is one of the most efficient mem- 
bers of this group. It is an active poison, but, as it is returned with 
the contents of the stomach, no danger attends its administration. It 
does not act so speedily as copper and zinc. It produces very little 
nausea, but, when the action begins, the effects are suddenly experi- 
enced, and are powerful, without leaving after-depression and sickness. 
It is not so well adapted to the treatment of narcotic poisoning as the 
copper and zinc sulphates, but it is the most desirable emetic in the 
treatment of croup. It was formerly much prescribed in this disease 
as an emetic, but it fell out of fashion until revived recently by Dr. 
Fordyce Barker. The author's experience in its use is, in the main, 
in accord with the much more extended experience of Dr. Barker. 

Administration. — As the yellow subsulphate of mercury has but 
little taste, it is easily administered to children. It should be prescribed 
in the form of powder, rubbed up with sugar of milk. The dose varies 
from two to five grains. Dr. Barker makes the useful suggestion that 
powders of this preparation, labeled " croup-powders," should be kept 
in every household, the children of which have a tendency to attacks 
of croup. It should be given when the first symptoms manifest them- 
selves, and its repetition will be governed by the state of the breathing. 

Alumen. — Powdered alum is a safe, efficient, but slow emetic. 
About a half -hour usually elapses after it is swallowed before the eme- 
sis occurs. It acts mechanically, produces no considerable nausea, and 
leaves behind no depression. As an emetic, its only use is in croup and 
diphtheria, administered with the view to cause a detachment of the 
false membrane. Some effect has been ascribed to the local action of 



SYSTEMIC EMETICS. 621 

the alum in its passage along the throat, but this opinion is scarcely 
tenable. 

Administration. — A teaspoonful of powdered alum may be ad- 
ministered in sirup, honey, or mucilage. It can be repeated, if need 
be, every half -hour. 

Sinapis. — Mustard is a stimulant, local emetic. It acts promptly 
and efficiently. In emergencies, other emetics not being available, it. 
may be employed in narcotic and other forms of poisoning. As an 
emetic it is especially adapted to depressed conditions of the system — 
for, while it causes vomiting, it stimulates the action of the heart. 
When, therefore, an emetic is indicated, and at the same time the cir- 
culation is feeble, the surface cold, and the functions of animal life 
oppressed, musifcard should be used. 

Administration. — A tea- to a dessert-spoonful of powdered mus- 
tard should be stirred up in a tumblerful of tepid water, and quickly 
swallowed. The irritant action of the mustard may be limited, and its 
emetic action promoted, by the free use of diluents. 

Scilla. — Squill is never employed as an emetic by and of itself. It 
is harsh and rather slow in action. In the form of the compound sirup 
of squills, it is not unfrequently used for this purpose, especially in 
domestic practice, but the emetic property of this combination is due 
chiefly to the tartar-emetic which it contains. 

SYSTEMIC EMETICS. 

Apomorphine. — Apomorphinw Hydrocliloras. — Hydrochl orate of 
apomorphine. The hydrochlorate of an artificial alkaloid obtained by 
the action of strong acids upon morphine contained in closed tubes and 
subjected to a somewhat elevated temperature. It is obtained also by 
the action of chloride of zinc in solution on morphine. It is a whitish 
powder, which becomes greenish by absorption of moisture. It is solu- 
ble in water, and it may, therefore, be administered in this menstruum. 
Dose, gr. fa to gr. -J. If given hypodermatically, gr. fa is sufficient ; 
if by the stomach, gr. -J. As it undergoes important changes when in 
contact with water, the solution for hypodermatic use should be made 
when required. 

Physiological Actions. — Whether injected under the skin or 
taken into the stomach, apomorphine causes vomiting. The rate at 
which it moves to, affect the stomach depends somewhat on the dose 
administered. From five to twenty minutes usually elapse after the 
hypodermatic injection before vomiting begins. The act of vomiting 
is preceded by very little nausea, the contents of the stomach are usu- 
ally thoroughly evacuated, and the vomiting recurs a few times at in- 
tervals of a quarter to a half hour. In young subjects very consider- 



622 EVACUANTS. 

able depression has been observed to be produced by it, and dangerous 
symptoms of cardiac paralysis have followed its emetic action in a few 
instances. These clinical facts seem to contradict the experimental 
observations of Siebert and Moerz, who have shown that apomorphine 
does not affect the blood-pressure, and that the pulse rises when emesis 
comes on, reaches its maximum during vomiting, and declines in the 
interval. The cardiac depression which has been observed, clinically, 
may have been the result of idiosyncrasy, yet we should not lose sight 
of the fact observed by Harnack, that in cold-blooded animals it may 
be produced experimentally. 

Apomorphine causes at first increased rapidity of the respiration, 
afterward diminishes the force and depth of the movements, and final- 
ly arrests them. As this result occurs when the vagi are divided, the 
drug must necessarily first excite and afterward exhaust the irritability 
of the respiratory center. Apomorphine has no appreciable influence 
on the temperature. 

As respects its influence on the nervous system, apomorphine is at 
first strongly excitant. Afterward it causes muscular tremblings, fol- 
lowed by paralysis and convulsions. The muscular irritability is im- 
paired but not destroyed, and the functions of motor and sensory 
nerves remain intact ; hence it may be concluded that the convulsant 
action of this agent is due to a direct impression on the spinal cord 
(the spasm-center). 

Therapy. — Apomorphine is indicated as an emetic when swallow- 
ing is difficult or impossible, and when very prompt action is neces- 
sary. As it produces vomiting by its spinal action, profound narcosis 
will prevent it, and hence, in narcotic poisoning, it may fail of effect 
unless administered before narcosis has supervened. It is a suitable 
emetic when it is desired to empty promptly an overloaded stomach. 
It is to be preferred to all emetics which must be introduced into the 
stomach, when this viscus is in a state of inflammation, for it is best 
given subcutaneously. Apomorphine has been administered as an 
emetic in suffocative catarrh, to empty mechanically the bronchial 
tubes, but it produced serious depression — a result which might have 
been a priori predicted, since this drug exerts a paralyzing action on 
the respiratory organs. It has also been given as an expectorant, but 
on insufficient data, for it does not seem to have an effect upon the 
vagi, and, as above stated, at first it excites the respiration movements, 
and afterward paralyzes them. 

As compared with its congeners, morphine and codeine, it is more 
excitant than morphine and codeine, and without their hypnotic and 
anodyne properties. As respects its convulsant action in animals, it 
has close physiological relations to narcotine and thebaine. Some clini- 
cal experiences have shown (Riegel und Bohm) that apomorphine 
causes heaviness in the head, giddiness, drowsiness, yawning, mental 



SYSTEMIC EMETICS. 623 

hebetude, etc. The trials in which these results were noted were made 
with Merck's preparation of apomorphine. 

Authorities referred to : 

Gee, Dr. Samuel. Note upon Apomorphia and Chlorocodide. St. Bartholomew's Hos- 
pital Reports, vol. v, 1869. 

Harnack, Dr. E. Arch.f. experimented Pathologie urid Pharmakologie, vol. ii, p. 291. 

Hermann, Dr. L. Lehrbuch der experimentellen Toxicologic, p. 381. 

Husemann, Dr. Theod. Handbuch, etc., zweiter Band, p. 615. 

Moerz, Dr. A. Prag. Vjhrsbr., 76, 1872. Abstracted in Schmidt's Jahrbucher, vol. 
clvii, p. 12. 

Quehl, Dr. Max. Ueber die phys. Wirhungen des Apomorphia. Schmidt's Jahr- 
bucher, vol. civ, p. 14, et seq. 

Riegel und Bohm. Arch. f. hlin. Med., vol. ix, 2, p. 211, 1871. 

Siebert, Dr. Vincent. Untersuchungen uber die physiol. Wirhungen des Apomorphin. 
Abstracted in Schmidt's Jahrbucher, vol. civ, p. 14, et seq. 

Ipecacuanha. — Ipecacuanha. The root of Cephaelis ipecacuanha 
A. Richard (Nat. Ord. Rubiaceas). (U. S. P.) Racine d ^ipecacuanha t 
Fr. ; Brechwurzel, Ger. 

Extractum Ipecacuanhas Fluidum. — Fluid extract of ipecacuanha. 
Dose, hi ij — 3 j. 

Syrupus Ipecacuanhas. — Sirup of ipecacuanha (fluid extract, § ij ; 
sirup, I xxx). Dose, 3 j — 1 ss. 

Tinctura Ipecacuanhas et Opii. — (Deodorized tincture of opium 
and fluid extract of ipecac.) Dose, tt[ v — ni xv. A liquid equivalent 
of Dover's powder. 

Trochisci Ipecacuanhas. — Troches of ipecacuanha (ipecac, traga- 
canth, arrow-root, sugar, and sirup of orange-peel). Dose, one or 
more. Each troche contains one fourth of a grain of ipecacuanha. 

Trochisci Morphinas et Ipecacuanhas. — Troches of morphine and 
ipecacuanha (each troche contains one fortieth of a grain of morphine, 
and one twelfth of a grain of ipecac). 

Vinum Ipecacuanhas. — Wine of ipecacuanha (fluid extract of ipe- 
cac, ? ij ; sherry wine, J xxx). Dose, tti j — 3 j. 

Pulvis Ipecacuanhas et Opii. — Compound powder of ipecacuan- 
ha. Dover's powder. Ten grains contain one grain each of ipecac 
and opium, and eight grains of sugar of milk. This preparation has 
already been discussed in the article on opium, and requires no con- 
sideration here. 

Composition. — Ipecacuanha contains an active principle, designated 
emetina or emetine. This exists in the bark of the root, in combina- 
tion with a peculiar acid — ipecacuanhic acid. The alkaloid is found 
in the root in a proportion somewhat less than one per cent. It is a 
bitter, inodorous, and amorphous substance, colorless, and alkaline in 
reaction. It is freely soluble in chloroform, and only slightly so in 
ether. Ipecacuanhic acid is a glucoside, and is chemically related to 
kinic and caffetannic acids. 



624 EVACUANTS. 

Antagonists and Incompatibles. — The salts of lead and mer- 
cury, the vegetable acids, and astringent infusions, are incompatible. 
The tannate of emetine is extremely insoluble. Bismuth, carbolic acid, 
hydrocyanic acid, and narcotics generally, hinder its emetic action. 

Synergists. — The emetics — those by local action and the systemic 
— favor the vomitive action of ipecac. Its effects on the skin and bron- 
chial mucous membrane are promoted by opium, warm diluents, etc. 

Physiological Actions. — Inunctions of ipecacuanha excite very 
considerable irritation of the skin : at first, small, isolated pustules ap- 
pear, and these are followed by large pustules and ulceration (Duck- 
worth). When applied to the mucous membrane of the nares, it pro- 
duces a sensation of heat, and causes sneezing. Some persons are so 
susceptible to its action that the smallest quantity inhaled will induce 
an asthmatic paroxysm. 

Administered by the stomach in small doses (from one eighth to 
one quarter of a grain), ipecacuanha acts as a stomachic tonic, and 
probably increases the gastric secretions. In larger doses (from five 
grains to a scruple), it is nauseant and emetic ; but the sickness which 
it causes is not severe, and the vomiting is not accompanied nor fol- 
lowed by much depression. Its action as an emetic is rather slow, 
from twenty minutes to a half-hour being required, and is not per- 
sistent. Repetition of large doses will, in most cases, but not invari- 
ably, produce a condition of tolerance, when vomiting does not occur, 
but a cathartic action is induced, the stools having a peculiar bilious 
character, appropriately designated " ipecacuanha-stools." Both vomit- 
ing and purging are sometimes produced by an emetic of ipecacuanha. 

Like other nauseants and emetics, ipecac increases the secretions of 
the broncho-pulmonary mucous membrane, and is, therefore, held to 
possess expectorant properties. More than any other agent of the class, 
it relaxes the skin, and promotes cutaneous transpiration. 

Ipecacuanha exerts but little influence over the circulation. In ani- 
mals, lethal doses of emetine cause death by paralysis of the muscles 
of respiration, the heart continuing in action after the cessation of the 
respiratory movements (D'Ornellas). The temperature of the surface 
falls, but the internal temperature remains the same, or rises somewhat, 
owing, it is said (D'Ornellas), to the irritant action of the agent on the 
intestinal mucous membrane. 

In the post-mortem examination of animals killed by emetine, very 
considerable gastro-intestinal irritation is found. The lungs are some- 
times seen to be hypersemic and presenting patches of hepatization, 
and sometimes exsanguine, but the former condition is more frequently 
observed. As the most common state of the lungs, caused by lethal 
doses of ipecac, is similar to that which is induced by section of the 
vagi, it is a reasonable conjecture that it has a special action on these 
nerves — according to Chouppe, on the terminal filaments of the vagi. 



SYSTEMIC EMETICS. 625 

The elimination of emetine takes place in large part by the gastro- 
intestinal mucous membrane, and it is found in the secretions. 

Therapy. — For ordinary purposes no emetic is more safe and effi- 
cient than ipecacuanha. As. it causes but little depression, and is free 
from irritant effects in ordinary doses, it may be given in conditions of 
the system in which tartar-emetic and the other mineral emetics are 
inadmissible. When the stomach is to be relieved of undigested ali- 
ment, ipecacuanha is the most suitable emetic. Attacks of acute indi- 
gestion, migraine, and the so-called bilious sick-headache, may not un- 
frequently be cut short by an ipecac-vomit. The good effects of the 
vomitive treatment are, not unfrequently, most strikingly exhibited 
in the beginning of continued fevers, the eruptive fevers, erysipelas, 
and periodical fevers. It has been alleged that fevers are sometimes 
" aborted " in this way. In denying the possibility of such results, it 
must be admitted that clinical experience has shown the good effects 
of the practice on the subsequent course of the malady. Formerly 
an ipecacuanha- emetic was much more frequently emplyed at the out- 
set of fevers than is the fashion at present, and the author is con- 
vinced that this mode of treatment should be resorted to now in suit- 
able cases. The indications for the use of emetic doses of ipecac- 
uanha, in the fevers above named, are these : a heavily-coated tongue, 
much nausea and ineffectual efforts to vomit, a strong sense of epigas- 
tric oppression, icterus or an icterode hue of the surface, a hot and dry 
skin, acid and turbid urine. When these symptoms are present in 
cases of malarial fever, the antiperiodic remedies will be much more 
effective in their action if their administration has been preceded by 
an ipecacuanha-emetic. 

In all the cases in which emetics are employed for mechanical effects, 
as in membranous croup), capillary bronchitis, foreign bodies lodged, 
etc., ipecacuanha may be used. In croup it is not so effective as the 
yellow subsulphate of mercury ; in capillary bronchitis, as tartar-emetic; 
but, as respects the latter disease, ipecacuanha is to be preferred in the 
very young or very old, and in those debilitated by any cause. In the 
domestic treatment of laryngismus stridulus an emetic dose of the 
sirup of ipecac is the most usual remedy. 

As an emetic, twenty grains of the powder of ipecacuanha may be 
diffused in a cup of warm water, and a tablespoonful of the mixture 
exhibited every fifteen minutes until emesis occurs. Two grains may 
cause vomiting ; and four grains will usually act efficiently ; hence a 
good method of proceeding, when an emetic effect is desired, is to ex- 
hibit a powder of four grains in a tablespoonful of warm water every 
fifteen minutes until vomiting occurs. The action will be facilitated 
by drinking freely of warm water ; but, if the systemic impression of 
the ipecacuanha is desired, the patient should retain the recumbent post- 
ure, and all fluids should be withheld. If the cathartic as well as the 
40 



626 EYACUANTS. 

emetic action is sought for, some weak animal broth should be given 
when the stomach is emptied of its contents. If free action of the skin 
is to be promoted, as soon as the vomiting has ceased warm aromatic 
infusions should be administered, and the patient should be covered 
with blankets. 

It has long been known that ipecacuanha, in small doses, has the 
power to arrest certain kinds of vomiting. Attention has recently been 
recalled to this curious fact. It is in nervous vomiting more especially 
that this remedy is useful : for example, in the vomiting of pregnancy, 
vomiting of. drunkards, vomiting of migraine, etc. A minim of the 
vinum ipecacuanha?, given every half -hour or hour in a little water, will 
sometimes relieve these cases in a very remarkable manner ; but it very 
frequently fails, and there are no indications at present known which 
will enable the practitioner to determine beforehand whether it will or 
will not be successful. 

It is a singular fact, showing the remarkable phases through which 
professional opinion passes, that ipecacuanha, which was introduced at 
the close of the seventeenth century as a remedy for dysentery, after a 
time ceased to be employed in this disease, but has again been restored 
to the estimation in which it was originally held. Epidemic dysentery, 
especially of malarious and tropical countries, is the form of the disease 
to the cure of which ipecacuanha seems best adapted. The author has 
used it with much success in acute dysentery, as it occurs in the interior 
valley of this continent. When the characteristic ipecacuanha-stools 
are produced, the tormina and tenesmus cease, and the dejections soon 
become feculent ; the skin, previously dry and hot, becomes moist and 
cool, and a refreshing calm is experienced. Large doses of ipecacuanha 
are required in the treatment of acute dysentery. In the severe attacks 
of tropical regions, from twenty to sixty grains are given for the initial 
dose, and the quantity subsequently administered depends on the effect 
— usually about twenty grains every four, six, or eight hours. It is im- 
portant to establish tolerance of the remedy as speedily as possible. If 
the first dose be rejected, subsequent ones may be retained. Various 
expedients may be resorted to in order to secure the retention of these 
large doses. The ipecacuanha may be combined with some opium and 
aromatic powder : 1$, Ipecacuanha?, 3 ss ; opium, gr. j ; pulv. aromat., 
grs. v. M. Ft. pulv. no. j. After the dose of ipecacuanha is adminis- 
tered a sinapism may be applied to the epigastrium, and an enema of 
laudanum and starch, or the subcutaneous injection of morphine, may be 
practiced. Milk is an excellent vehicle for the administration of ipe- 
cacuanha. In the cases of dysentery treated on this plan by the author, 
he has found that doses of fifteen grains, given in milk, were generally 
pretty well borne. It not unfrequently happens, however, that toler- 
ance can not be established, and the remedy must then be abandoned. 
Some patients so object to the nausea produced by it as to be reluctant 



SYSTEMIC EMETICS. 627 

to take it, and others, after one trial, decline to continue the treatment. 
Notwithstanding these drawbacks, it must be conceded that ipecacu- 
anha is a most valuable remedy in epidemic and sporadic dysentery. It 
has been shown that in India, before the introduction of this method 
of treatment, the mortality from dysentery was about 79 '6 per one 
thousand of cases ; but, since the use of ipecacuanha has been general- 
ized, the mortality has fallen to 20*15 per one thousand of cases. 

Ipecacuanha has also been used with success in chronic dysentery, 
but, in the author's experience, it is by no means so beneficial as in the 
acute. It succeeds best in those cases which are the outgrowth of acute 
attacks, and in which the intestinal ulcerations are not far advanced. 
The rules for its administration are the same in chronic as in acute dys- 
entery. In the summer dysentery and diarrhoea of teething children 
ipecacuanha is often extremely serviceable. The special indication for 
its use is the occurrence of greenish stools, containing mucus and some- 
times blood. These stools are usually voided with much pain and 
straining. At the same time the skin is harsh and dry, the tongue 
rather dry and pasty, or glazed, and there is great thirst, although little 
or no fever may be present. Ipecacuanha changes the character of the 
stools, induces perspiration, and allays the thirst and dryness of the 
mouth. From two to five grains every two hours may be given in these 
cases, or it may be administered with pepsin, oxide of zinc, bismuth, 
or other remedies, fy Ipecacuanhas, grs. xij ; bismuthi subcarb., 3 j ; 
pepsinae sacch., 3 ss. M. Ft. pulv. no. xij. Sig.: One in milk every 
two hours. 

The evidence is conclusive that ipecacuanha possesses very valuable 
antihaemorrhagic powers. It has been successful in haemoptysis, epis- 
taxis, menorrhagia, postpartum haemorrhage, etc. As Peter has ob- 
served, " the vomitive medication " (ipecacuanha) " arrests not only 
haemoptysis but all kinds of haemorrhage, and is, therefore, a general 
antihaemorrhagic medication." In haemorrhages the ipecacuanha should 
be given in frequently-repeated doses until vomiting ensues ; usually, 
when this effect is produced the haemorrhage ceases. Other autihaem- 
orrhagic agents may be combined with ipecacuanha. r> Ext. ipecac, 
fluidi, 3 ij ; ext. ergotae fluidi, 3 iv ; ext. digitalis fluidi, 3 ij. M. 
Sig. : Thirty minims to a teaspoonfid at a dose, as required. The 
author has witnessed excellent results from this combination in hae- 
moptysis and menorrhagia. In the treatment of post-partum haemor- 
rhage, the most suitable combination is fluid extract of ipecacuanha 
and fluid extract of ergot. Trousseau strongly urges the employment 
of ipecacuanha in post-partum haemorrhage, and, indeed, in the various 
accidents which occur in the puerperal state, among which he desig- 
nates gastro-intestinal irritation, suppression of the lochia, subacute 
metritis, pelvic cellulitis, bronchial catarrh, subacute pneumonia, etc. 
" He has not observed the least ill-result from this practice ; on the 



628 EVACUANTS. 

contrary, in the most of these cases, he has obtained either a cure or 
a notable amendment " (Trousseau et Pidoux). 

Certain acute affections of the broncho-pulmonary mucous mem- 
brane are much benefited by non-emetic doses of ipecacuanha ; for 
example, acute catarrh of the nasal and bronchial mucous membrane, 
hay-asthma, capillary bronchitis. An emetic dose will cut short an 
attack of laryngismus stridulus. An occasional emetic gives great 
relief in whooping-cough, when there is profuse bronchial secretion. 
Non-emetic doses of the fluid extract (tt[ j — t\[ iij) diminish the violence 
of the spasms in this disease. Nauseating and emetic doses are ser- 
viceable in the attacks of spasmodic asthma, but the good effects of the 
remedy are lost by repetition. Ordinary colds, especially in children, 
are benefited by doses sufficient to produce slight nausea but not vomit- 
ing. A troublesome cough at night, which prevents sleep, may not 
unfrequently be arrested by a dose at bed-hour of some one of the 
ipecacuanha preparations. For these various purposes the wine or the 
fluid extract may be used, but the latter preparation is much more 
trustworthy and effective than the former. 

Authorities referred to : 

Chouppe, M. Archives de Physiologie, No. 1, 1875, p. 101. 

D'Ornellas, Dr. Antonio-Evaristo. Du Vomissement, etc. Bulletin Gen. de Therap., 
vol. lxxxiv, pp. 193, 244, 295, 348. 

Duckworth, Dr. Dyce. £2. Bartholomew's Hospital Reports, vol. v, p. 287, 1869. 

Fluckiger and Hanbury. Pharmacographia, article Ipecacuanha. 

Fuller, C. C. London Lancet, December 4, 1869. On the Action of Ipecacuanha. 

Husemann, Dr. Theodor. Handbuch dcr gesammten Arzneimittellehre, zweiter Band, 
p. 608, et seq. 

Peter, M. Michel. A propos des Hemoptysies et de leur Traitement par la Medication 
Vomitive. Bulletin Gen. Therap., vol. lxxvii. 

Phillips, Dr. C. D. F. On the Actions and Uses of Ipecacuanha. The Practitioner, 
vol. iii, p. 276, et seq. 

Ibid. Materia Medica and Tlierapeutics, article Ipecacuanha. 

Kinger, Dr. Sydney. Handbook of Tlierapeutics. 

Trousseau et Pidoux. Traite de Therapeutique et Mat. Med., huitieme edition, vol. 
i, p. 733, et seq. 

Antimonii et Potassii Tartras. — Tartrate of Antimony and Po- 
tassa. — Tartar-emetic. 

This is a powerfully spoliative and depressing emetic, which has 
already been discussed under the head of " Agents promoting Destruc- 
tive Metamorphosis." It was formerly much employed as an emetic 
in croup, capillary bronchitis, and at the onset of fevers and inflamma- 
tions ; but the local irritation, as well as the systemic depression which 
follows its use, has led to its almost entire abandonment for these 
purposes. 

Administration. — Six grains may be dissolved in four ounces of 
water, and a tablespoonful be given every fifteen minutes until emesis 



CATHARTICS. 629 

occurs. Ipecacuanha and tartar-emetic are frequently administered 
together — twenty grains of the former and two grains of the latter. 

CATHARTICS. 

Purgatives are divisible into several groups, according to the nature 
of their action. 

Laxatives are medicines which stimulate the intestinal movements, 
without increasing to any considerable extent, at least, the intestinal 
secretions. 

Saline Purgatives excite increased secretion, while at the same 
time they hasten the peristaltic action. The dejections which are 
produced by them are loose and watery. 

Mercurial Purgatives, chiefly calomel and blue mass, exert an in- 
fluence peculiar to themselves. "Without expressing an opinion at 
present, for or against their supposed cholagogue effects, the author 
believes that they differ so much in their action from other purgatives 
as to be appropriately placed in a separate class. 

Tonic-astringent and Resin-hearing Purgatives. — These affect the 
liver and the glandular appendages of the mucous membrane, and in- 
crease the tonicity of the muscular layer of the intestine. They in- 
crease the proper secretion of the glands, and do not merely cause an 
outward osmosis of fluid from the vessels. 

Hydragogue Purgatives act with great energy, and not only in- 
crease the glandular secretions, but cause a very abundant outward 
diffusion, so that the dejections which they produce are extremely 
watery. This group of purgatives also excite very rapid and violent 
peristaltic movements. 

Laxatives. — Manna. — Manna. The concrete, saccharine exudation, 
in flakes, of Fraxinus ornus Linne (Nat. Ord. Oleacece). Dose, 3 j — 
1 ij, according to age. 

Composition and Properties. — Manna has a sweetish, rather 
mawkish taste ; is soluble, when pure, in three parts of cold water, and 
in its own weight of boiling water. It contains a sugar — manna- 
sugar or mannite, which constitutes from seventy to eighty per cent 
of the best specimens of manna. It is said to contain dextrin, or a 
mucilage having similar reactions, and ether extracts from it in small 
quantity a slightly acrid, reddish-brown resin, on which the laxative 
property of manna probably depends. 

• Actions and Uses. — Manna is a very mild laxative, but, when 
administered alone, is apt to cause griping. It is rather slow in its 
operation, but is free from irritating qualities, and leaves no unpleas- 
ant after-effects. It is most frequently combined with other purga- 
tives — senna chiefly — the operation of which it aids, and at the same 
time renders less drastic. It is rarely given alone, and only to chil- 



630 EVAOUANTS. 

dren and pregnant women. Formerly it was used as a laxative in 
hemorrhoidal affections. 

Sulphur. — Sulphur lotum (washed sulphur). Sulphur sublimatum 
(sublimed sulphur). Washed sulphur only should be used as a laxa- 
tive. Sublimed sulphur contains a trace of acid which imparts to it a 
griping quality. Dose, 3 j — 3 iij. 

Actions and Uses. — Sulphur is insoluble in water, but dissolves in 
alkaline solutions and in the volatile and fixed oils. In the small in- 
testine, sulphur is placed under favorable conditions for absorption. 
That it does enter the blood is proved by the fact that it appears in 
the perspiration, urine, milk, etc. Silver coins, carried in the pockets 
of those taking sulphur, are discolored by the formation of the sul- 
phide of silver. Considerable sulphureted-hydrogen gas is produced 
as a result of the chemical changes in the intestines, and a quantity of 
offensive flatus is an unpleasant sequel of its administration. The in- 
testinal secretions are somewhat increased by it, and the stools are 
therefore softer. It is a very mild laxative. Combination of sulphur 
and bitartrate of potassa or magnesia is occasionally resorted to, es- 
pecially in domestic practice, for the purpose of increasing the laxative 
action. 

Sufficient attention has already been paid to the sulphur compounds, 
and it only now remains to speak of sulphur as a laxative. It is used 
chiefly to render the stools softer and more easily voided in cases of 
hmmorrhoids, fissures of the anus, and after surgical operations about 
the pelvic organs. It is used also as a laxative in skin-diseases, chronic 
rheumatism, sciatica, and lead-cachexia, conjoined usually with sul- 
phur-baths, the sulphurous mineral waters, and other appropriate med- 
ication. 

Pulvis Glycyrrhiz^e Compositus is an efficient laxative. It is 
made as follows : Senna-leaves, eighteen parts ; licorice-root, sixteen 
parts ; fennel-seeds, eight parts ; washed sulphur, eight parts ; re- 
fined sugar, fifty parts. M. Sig. : A teaspoonful at a dose. 

Magnesia. — Magnesia. — Light magnesia. A white, very light and 
very fine powder, slowly absorbing carbonic acid from the air, odorless, 
having an earthy but no saline taste, and a faintly alkaline reaction 
when moistened with water. It is almost insoluble in water, or in alco- 
hol, etc. Dose, 3 ss — 3 ij, or more. 

Magnesia Ponder osa. — Heavy magnesia. A white, dense, and 
very fine powder, corresponding in all other properties to the above. 
Dose, 3 ss — 3 ij. 

Magnesii Carbonas. — Carbonate of magnesia. Light, white, fria- 
ble masses, or a light, white powder, odorless and tasteless, insoluble 
in alcohol, and almost insoluble in water. Dose, 3 ss — 3 ij. 



CATHARTICS. 631 

Mistura Magnesias et Asafoetidce. — Mixture of magnesia and asa- 
foetida. (Carbonate of magnesium, five parts ; tincture of asafcetida, 
seven parts ; tincture of opium, one part ; sugar, ten parts ; and suffi- 
cient distilled water to make up one hundred parts. Dewees's for- 
mula.) Dose, one fourth to one teaspoonful. 

Actions and Uses. — A mild antacid laxative. In the stomach it 
neutralizes any free acid it meets with, and the resulting salt has a 
laxative action. It is used to correct acidity, the carbonate being pre- 
ferred when there is an irritable state of the stomach, because the 
carbonic acid, which is set free by the action of the stomach acid, is a 
local sedative and anodyne. If magnesia does not enter into combi- 
nation with the stomach acid, no laxative effect is produced. Under 
these circumstances a solution of citric acid or lemonade, taken after 
the magnesia, will cause it to act. Magnesia is a useful antacid and 
laxative in sick-headache, especially when accompanied by acidity and 
constipation. It has been employed also in gouty affections, and in 
Uthiasis (uric acid) ; but it is much inferior to the potash salts in 
these affections. In the intestinal indigestion of infants, attended 
with flatulence, magnesia is much prescribed in conjunction with car- 
minatives. Dewees's formula for flatulent colic and diarrhoea in in- 
fants has been made official, and is given above as Mistura Magnesia} 
et Asafcetida}. The carminative of Dalby is similar in composition : ^ 
Magnesii carbonat, 3ij ; ol. menth. pip., gt. j ; ol. myrist., gtt. ij ; ol. 
anisi, gtt. iij ; tinct. castor., gtt. xxx ; tinct. asafcetid., gtt. xv ; tinct. 
ol. hedeomse, gtt. xv ; tinct. cardam. comp., gtt. xxx ; aquae menthse 
pip., 1 ij. M. Sig. : A teaspoonful, as necessary. 

Magnesia is frequently combined with other purgatives because of 
its antacid property. The following is Meigs's formula, gelsemium 
having been substituted for henbane : 1^ Magnesii carb., 3 ss ; mag- 
nesii sulphat., 3 iij ; spts. ammonias aromat., 3 j ; tinct. rhei, f ss ; tinct. 
gelsemii, 3 ss ; aquae menthaa pip., § iv. M. Sig. : A tablespoonful 
two or three times a day. 

It is unsafe to use magnesia in large quantity for lengthened peri- 
ods, owing to the fact that it may form intestinal concretions — a hy- 
drate of magnesia. Instances of this kind have been reported. 

Freshly-precipitated hydrate of magnesia is an antidote to arseni- 
ous acid in solution, but it is not so effective as the hydrated sesqui- 
oxide of iron. 

Oleum Ricini. — Castor-oil. Sidle de ricin, Fr. ; Castorol, Ger. A 
fixed oil expressed from the seed of Ricinus communis Linne (Nat. 
Ord. Euphorbiacece). Dose, 3 j — J j. 

Properties and Composition. — Castor-oil has a pale amber-color, 
a rather nauseous taste, and is quite viscid. Cold increases the viscid- 
ity. It has a specific gravity of about 0*96. It contains several fatty 



632 EVACUANTS. 

acids — -palmitic and ricinoleic — the latter peculiar to castor-oil. The 
seeds appear to contain a drastic constituent, which is more powerfully- 
purgative than the oil. The purer the oil, the less active its purgative 
property. 

Actions and Uses. — Castor-oil is a mild but very certain and effi- 
cient laxative. It operates in from four to six hours, causing but little 
pain, and producing copious stools. It increases but slightly the in- 
testinal secretions — hence the stools are not very liquid. Its purgative 
principle enters the blood, and the milk of the mother may in this 
way acquire a purgative property. It does not appear to have any 
effect upon the hepatic secretion. Rohrig's experiments, which dem- 
onstrated this point, have been confirmed by the subsequent investi- 
gations of Rutherford and Yignal. After the action of castor-oil has 
been completed, it may not unfrequently be seen floating on the stool ; 
yet Buchheim (Husemann) has been unable, after careful examination 
of the f seces, to discover in them castor-oil or any of its derivatives. 

Castor-oil is justly held in great esteem as a laxative for children, 
for pregnant ico)nen,for the puerperal state. When hardened f wees 
and irritating substances are to be removed from the intestinal canal, 
castor-oil is the most efficient purgative compatible with safety. When 
inflamed hemorrhoids, fissures of the anus, or surgical operations on 
the pelvic viscera, require the use of a mild, certain, but unirritating 
laxative, castor-oil should be selected. Unfortunately, its taste is so 
repugnant to many palates, that no considerations will overcome the 
disgust which it excites. No remedy is more useful in the diarrhoea 
of children, induced and maintained by undigested aliment or irritat- 
ing secretions. It is judicious practice, in these cases, to give a laxa- 
tive dose of castor-oil to empty the canal, and follow it with an opiate 
or enema of laudanum. The dysentery of children, and sporadic dys- 
entery of adults, especially after the more acute febrile symptoms have 
subsided, are generally very successfully managed by an emulsion of 
castor-oil : ty 01. ricini, f j ; mucil. acacise, syrup, simplicis, aa J ss ; 
aquae cinnamomi, J ij. M. Sig. : A tablespoonful every four to six 
hours. In cases of dysentery, when there are much pain, tenesmus, 
and frequent passages, ten to twenty drops of laudanum may be added 
to each dose ; when there are much depression, a low state of the ar- 
terial tension, and a dry, glazed tongue, five drops of turpentine may 
also be added. 

A poultice made of the leaves of the castor-oil plant applied to the 
breasts, it is said, has the power to promote the secretion of milk. 
Warm applications to the mammas undoubtedly stimulate their func- 
tional activity, but it is questionable whether castor-oil leaves have a 
special galactagogue property. It is said, however, that the inhabit- 
ants of the Cape Verd Islands have long been acquainted with this 
supposed property. The internal use of a fluid extract of the leaves 



CATHARTICS. 633 

has also, it is supposed, the power to determine an increased secretion 
of milk. Jaborandi will probably prove to be more effective in this 
respect than the ricinus communis. 

Saline Purgatives. — Many of these have been discussed elsewhere ; 
some of them are no longer employed in medical practice. The sul- 
phate and the citrate of magnesium may be regarded as typical repre- 
sentatives of the class, and hence, in a statement of their physiological 
actions and therapeutical applications, may be comprehended all that 
is of immediate and practical value on the subject. 

Magnesii Sulphas. — Sulphate of magnesium. Sulfate de magnesie, 
Fr. ; BittersalZy Ger. In colorless crystals, which slowly effloresce on 
exposure to the air, and are very soluble in water. Dose, 3 j — ? j. 

Magnesii Citras Granulatus. — A white, coarsely-granular salt, del- 
iquescent on exposure to air, odorless, having a mildly acidulous, re- 
freshing taste, and an acid reaction. Soluble with copious efferves- 
cence in two parts of water at 60° Fahr. ; almost insoluble in alcohol. 
Dose, 3 j — 3 iv. 

Liquor Magnesii Citratis. — Solution of citrate of magnesia. Dose, 
§ iv — 1 viij. A tablespoonful of the granular salt added to a half- 
tumblerful of water, and drunk during effervescence, is the quantity 
and the form in which it may also be taken. The bottled solution, 
which is also highly effervescent, must be drunk immediately on being 
poured out. It is a pleasant drink, and, when properly prepared, an 
active cathartic. 

Physiological Actions of Saline Purgatives. — As a general 
rule, saline cathartics are easily borne by the stomach ; especially is 
this true of the Epsom salts. The purgative action is due chiefly to 
increase of the intestinal secretions, and hence the stools are large and 
watery. Thiry and Radziejewski had apparently demonstrated that 
all purgatives acted by increasing the peristaltic movements, but ex- 
actly opposite results have been obtained by Moreau, whose observa- 
tions have been confirmed by Vulpian and Brunton. The conclusion 
reached by the last-named observer is expressed as follows : " Such 
positive results as these seem to prove that purgatives do cause a flow 
from the intestinal wall, quite as conclusively as experiments with 
Thiry's fistula do the opposite ; and, as the conditions under which the 
purgatives act on the intestines more nearly approach the normal in 
Moreau's than in Thiry's experiments, there can be little doubt that 
purgatives produce a decided secretion of fluid from the intestines, as 
well as accelerate peristaltic movements." Of the agents employed 
by Brunton in his experiments — croton-oil, elaterin, gamboge, jalapin, 
and sulphate of magnesia — the greatest secretion was caused by the 
latter. The results of the best directed experiments are, therefore, in 



634 EVACUANTS. 

accord with clinical observations, and it may hence be considered as 
established that saline cathartics produce an outpouring of fluid into 
the intestinal canal. This outward osmosis occurs chiefly from the 
vessels, and is not truly a secretion of the glandular appendages of the 
mucous membrane. 

Therapy. — The saline purgatives are indicated in acute inflamma- 
tory affections, as a part of the denutrition treatment. If the arterial 
tension is abnormally high, purgatives, especially the salines, lower it, 
as the sphygmographic tracings show. When a considerable quantity 
of serum is withdrawn from the intestinal vessels, the blood-pressure is 
necessarily diminished elsewhere (Brunton). Free transudation from 
the blood-vessels of the intestinal canal lessens the amount of work 
which the kidneys have to do, and, if these organs are hypeneraic, re- 
moves the congestion. Saline cathartics are therefore very important 
remedies in the treatment of renal and cardiac dropsy. Free purga- 
tion, also, influences the condition of the kidneys by reflex action. As 
a result of the lessened hyperemia of the kidneys, the diminution of 
the blood-pressure, and the reflex stimulation of these organs, the ac- 
tion of a purgative is often followed by greatly -increased activity of 
the renal function. In ascites from obstruction of the portal circula- 
tion, saline cathartics are even more conspicuously beneficial than in 
general dropsy — for in this case they affect directly the organs in- 
volved. Cholcernia, urosmia, oedema of the brain, increased intra- 
cranial blood-pressure from any cause, are conditions requiring the use 
of active saline cathartics. 

The most important applications of saline cathartics are in the treat- 
ment of various intestinal disorders. When the stomach is irritable, 
and the intestines inflamed, no other purgative is so well borne as Ep- 
som salts, and its use may be resorted to when any other agent of the 
kind would be inadmissible. Impactio?i of the ccecum, and typhlitis 
resulting from this cause, may be removed by the proper administration 
of this remedy. It is unsafe, by active and drastic purgatives, to at- 
tempt to unload the bowel — for these harsh measures will only aggra- 
vate the existing inflammation. Epsom salts will liquefy the fecal 
masses and deplete the vessels, and thus remove the obstruction with- 
out causing any irritation. Small doses frequently repeated are more 
suitable than a large purgative dose. Usually about a teaspoonful in a 
wineglassf ul of water, every three hours, will be the quantity required. 
Perityphlitis and the peritonitis arising from inflammation and perfora- 
tion of the appendix vermiformis are conditions in which purgatives of 
any kind are inadmissible. 

The constipation which accompanies lead-colic can be overcome by 
Epsom salts. $ Magnesii sulphatis, § j 5 acidi sulphuric, dil., 3 j ; 
aquae, § iv. M. Sig. : A tablespoonfid every three hours. As Brunton 
has pointed out, the administration of Epsom salts is a very important 



CATHARTICS. 635 

expedient in the treatment of the saturnine cachexia. Lead, as well 
as other minerals, mercury and copper, for example, is eliminated with 
the bile, and is discharged into the intestine, where it is again ab- 
sorbed. For an indefinite period, therefore, the absorption and dis- 
charge of the same metal may be going on ; and hence the utility of 
giving purgative doses of Epsom salts during the treatment of lead- 
poisoning. 

The most efficient treatment of acute dysentery is by the adminis- 
tration of sulphate of magnesia. It is especially adapted to the acute 
stage when there are fever, pain, tenesmus, and stools of mucus and 
blood. It lessens the hyperemia and causes fecal evacuations, with the 
result of relieving the pain and the distressing straining. It is admin- 
istered as follows : Take a sufficient quantity of sulphate of magnesia 
to saturate eight ounces of water, and to this saturated solution add 
one half ounce of diluted sulphuric acid. The dose of this is a table- 
spoonful every hour or two, in a wineglassful of water, until it oper- 
ates. Sulphate of morphine may be combined with it, or starch ene- 
mata with laudanum may be employed. 

The bleeding from hemorrhoids may sometimes be arrested by the 
above-described solution of Epsom salts and sulphuric acid, especially if 
the state of the hemorrhoidal vessels be due to constipation. Uterine 
hemorrhage caused by the presence of a fibroid, or by subinvolution, 
and congestion of the pelvic viscera, are not unfrequently relieved by 
the same agent when other agents apparently more powerful fail. 
When congestion of the pelvic organs, constipation, and anaemia coex- 
ist, the following is an efficient remedy : fy Magnesii sulphat., § j ; f erri 
sulphat., manganesii sulphat., aa 3] ; acid, sulphur, dil., 3 ij ; aqua?, J iv. 
M. Sig. : A tablespoonful in a wineglassful of water each morning 
before breakfast. For habitual constipation in those of full habit and 
active circulation, a daily morning dose of a teaspoonf ul of Epsom salts 
is often a permanently effective remedy. 

The disagreeable taste of Epsom salts is perfectly well covered by 
coffee. Boil for two minutes in an earthen vessel one ounce of sul- 
phate of magnesia and two and a half drachms of roasted coffee in a 
pint of water ; then remove from the fire, allow it to " draw " for a 
few minutes, and strain. 

The other saline purgatives belonging to this group are : 

Sodii Sutyhas, sulphate of sodium, Glauber's salts, 

Potassii Sulpthas, sulphate of potassium ; but both of these have 
long since ceased to be used. 

Sodii Phosphas, phosphate of soda, 

Potassii et Sodii Tartras, tartrate of potassium and sodium, Ro- 
chelle salts, and 

Pidvis Ejfervescens Compositus, effervescing aperient powders or 
Seidlitz powders, have been considered elsewhere. 



636 EVACUANTS. 

Potassii JBitartras, bitartrate of potassium, cremor tartar, may also 
be regarded as a member of this group, although it has but feeble pur- 
gative property. 

Mercurial Purgatives. — As the actions and uses of the mercurial 
preparations have been sufficiently discussed elsewhere, little need be 
said in addition as respects their applications as purgatives. 

Hydrargyri Chloridum Mite. — Mild chloride of mercury. Calo- 
mel. Dose as a cathartic, gr. j — grs. x. 

Massa Hydrargyri. — Mercurial pill. Blue mass. Dose, grs. v — 
grs. xv, as a cathartic. 

Actions and Uses. — These mercurial purgatives are rather slow in 
their action. A dose at bedtime will usually operate during the course 
of the following morning. One grain of calomel or five grains of 
mercurial pill will produce distinct purgative effects in most persons 
in about twelve hours, unless there be considerable habitual torpor of 
the bowels. They are apt to cause griping pains, nausea, and even 
vomiting, when the purgative effects begin. First brownish and bad- 
smelling, and afterward greenish stools, supposed formerly to be char- 
acteristic of the mercurial action, are produced. Much heated discus- 
sion has arisen as to the cholagogue action of mercury. Without 
entering into details on this point, it may be admitted that bile- 
elements are found in the stools from the action of mercury, as they 
are unquestionably found in the stools caused by some other purga- 
tives. The presence of bile-elements in the faeces discharged, only 
proves that mercurial cathartics swept them out with the other 
contents of the intestinal canal, and does not prove that an excitant 
action was exerted on the secretory function of the liver. The stored- 
up bile in the gall-bladder may be emptied into the intestine in obe- 
dience to a reflex influence transmitted from the intestinal mucous 
membrane irritated by the purgative. Experimental investigations 
must be invoked to determine the question whether mercurials actu- 
ally stimulate the liver to the production of an increased quantity of 
bile. In another place the experiments of Hughes Bennett's Edin- 
burgh Committee have been stated. Since the report of that commit- 
tee has made its appearance, the very accurate and painstaking inves- 
tigations of Rutherf ord\ and Yignal have been published. Rohrig had 
already determined as the result of his experiments that " with large 
doses (twenty grains for a dog) it rarely happened that the secretion 
of bile was recalled after it had come to a standstill, although this 
agent can increase the secretion when it is only diminishing." Ruth- 
erford and Vignal arrived at the following conclusions as the results 
of their experiments with calomel : " 1. An increase of the biliary se- 
cretion followed the administration of two successive doses of ten 
grains of calomel in one case (Experiments 30). Diminution of the 



CATHARTICS. G37 

secretion was the only result of the same doses given under similar 
circumstances- in other two cases (Experiments 31 and 32) ; and it 
was the most definite result of the administration of four successive 
doses of three grains in another case (Experiment 33). 2. In all the 
four experiments the calomel had a purgative effect. 3. Analysis of 
the bile secreted during the calomel purgation in Experiment 33 
showed that, notwithstanding a diminution in the quantity of bile 
secreted, the percentage amount of solids had become less." The 
results of experiment render it probable that mercurials do not in- 
crease the secretion of bile in animals, but we are not without con- 
firmatory evidence in the human subject. In the cases of biliary fis- 
tulas (accidental) observed by Westphalen and Ranke, no increase, but 
rather a diminution in the amount of bile, followed the exhibition of 
calomel in purgative doses. 

That the purgative action of mercurials has a distinctive and pe- 
culiar quality, a vast clinical experience attests. The stools are rather 
different from those caused by other purgatives, and the therapeutical 
effects are, it is generally held, sui generis. Whatever peculiarity per- 
tains to the purgative action of mercurials is probably due to the fact 
that they greatly increase the elimination of the products of waste, or 
retrograde metamorphosis of tissue, by the intestinal glandular appa- 
ratus. 

As a purgative, the use of mercury is restricted to those cases in 
which a deficiency of bile is supposed to be the cause of the morbid 
state — clay-colored stools, jaundice from catarrh of the gall-ducts ; and 
to those cases, singularly enough, in which bile is supposed to be in ex- 
cess — biliousness, so called, jaundice from excessive production of bile, 
etc. For further remarks on the actions and uses of mercury the 
reader is referred to the section on remedies used to promote destruc- 
tive metamorphosis. 

TONIC-ASTRINGENT AND RESIX-BEARIXG PURGATIVES. 

Senna. — Senna. The leaflets of Cassia acutifolia Delile (Alexan- 
dria senna), and of Cassia elongata Lemaire-Lisancourt (India senna), 
(Nat. Ord. Eegumi?iosce, Ccesalpinacece) . (IT. S. P.) Feuilles de sene, 
Fr. ; Sennesblatter, Ger. 

Confectio Sennas. — Confection of senna. (Senna, coriander-seed, 
licorice, figs, prunes, tamarinds, cassia.) Dose, 3 j — 3 ij. 

Extractum Sennce Fluidum. — Fluid extract of senna. Dose, § ss. 

Infusum Sennce Compositum. — Infusion of senna. (Senna, § j ; 
coriander-seed, 3 j ; boiling water, Oj.) Dose, § iv. 

Syrupus Sennce. — Sirup of senna. Dose, 3 ss— 3 ij. 

Composition. — The active constituents of senna prove to be a pe- 
culiar colloid body, and an acid, to which has been given the name 



638 EVACUANTS. 

cathartic acid. It has been shown that " cathartate of ammonia pos- 
sesses, in a concentrated form, the purgative activity of the original 
drug." Two bitter principles have been obtained from senna — senna- 
crol and sennapicrin. It contains also a peculiar sugar — catharto- 
mannite. 

Actions and Uses. — The taste of senna is nauseous and bitter. In 
infusion — the form in which it is most usually prescribed — it is most 
disagreeable in odor as well as taste. It produces a sense of warmth 
in the stomach, and causes much flatulence and griping, which may, 
however, be prevented by combination with aromatics. Its active 
principles are absorbed, and the milk of the mother taking senna ac- 
quires a purgative property. It is a very efficient cathartic, producing 
copious liquid stools in about four hours. It does not cause inflamma- 
tion or hypercatharsis, and its purgative action is not followed by in- 
testinal torpor and constipation. It were, therefore, a very safe and 
serviceable cathartic, if it were not so disagreeable. 

The confection of senna is a palatable preparation, and a mild laxa- 
tive, operating without any disturbance. It is used chiefly to correct 
the constipation of 'pregnancy ', but it is highly prized by some patients 
as a remedy for habitual constipation. It is also taken to procure soft 
and easy evacuations in hemorrhoids, fissures of the anus, etc. A 
large bolus (one hundred and twenty grains), taken at bedtime, will 
operate gently on the following morning. The fluid extract of senna 
is a form for the administration of this drug more agreeable than the 
infusion. These two preparations are very excellent cathartics to over- 
come constipation, especially when ordinary purgatives fail. 

The action of senna is much improved by combination with other 
purgatives, and with aromatics. The well-known "black draught" is 
an infusion of senna with sulphate of magnesia — one ounce of the latter 
dissolved in four ounces of the former. By the addition of coffee, the 
odor and flavor of senna may be rendered more tolerable. Two 
drachms of senna and one drachm of coffee may be infused in three 
ounces each of hot milk and boiling water, and the whole drunk after 
twelve hours. 

Rheum. — Rhubarb. The root of Rheum officinale Baillon, and of 
other undetermined species of Rheum (Nat. Ord. Polygonacem). Hhu- 
barbe, Fr. ; Rhabarber, Ger. 

Extractum lihei. — Extract of rhubarb. Dose, grs. x — grs. xv. 

Extractum JRhei Fluidum. — Fluid extract of rhubarb. Dose, 3 ss 

-3ij. 

Pilidce JRhei. — Rhubarb-pills. Each pill contains three grams of 
rhubarb and one grain of soap. 

Pilule Bhei Composite. — Compound pills of rhubarb. (Rhubarb, 
purified aloes, myrrh.) Dose, 2 — 4 pills. 



CATHARTICS. 639 

Syrupus Rhei. — Sirup of rhubarb. (Fluid extract, 3 iij ; simple 
sirup, § xxix.) Dose, 3 ss— 3 ij. 

Tinctura Rhei Aromaticus. — Aromatic tincture of rhubarb. (Rhu- 
barb, cloves, cinnamon, nutmeg.) Dose, 3 ss — 3 ij. 

Tinctura Rhei. — Tincture of rhubarb. Dose, 3 j — 3 ss. 

Tinctura Rhei Dulcis. — Sweet tincture of rhubarb. Dose, § ss — 

Vinum Rhei. — Wine of rhubarb. (Rhubarb, calamus, stronger 
white wine.) Dose, 3 j — § ss. 

Pulvis Rhei Compositus. — Compound powder of rhubarb. Dose, 
a teaspoonful. 

Composition. — Rhubarb contains a number of substances which 
have been isolated, but its composition has not yet been accurately 
determined. It contains two acids, rheo-tannic and rhewnic, a resin- 
ous body, phceoretin, and chrysophan, or chrysophanic acid. 

Physiological Actions. — In small doses, rhubarb is a tonic astrin- 
gent. It promotes the appetite and the digestive power, and, by virtue 
of its tannin, is astringent and diminishes peristalsis. As it contains 
also a purgative principle, in sufficient doses cathartic effects follow its 
administration. The stools are stained by the coloring-matters of the 
rhubarb, are of a yellowish-brown color, and are rather soft without 
being watery. After the purgative action has ended, the astringent 
constituents assert their power and constipation results. As the stools 
present an appearance to which the term " bilious " was applied, it 
was formerly supposed that rhubarb had the power to increase the 
flow of bile ; more recently it has been universally conceded that the 
coloring-matter of rhubarb produces the peculiar tint referred to. The 
latest investigations of Rutherford and Yignal have, apparently, very 
conclusively shown that rhubarb really possesses the property anciently 
ascribed to it, and that it must be placed among the cholagogue medi- 
cines. As it is now known to increase the flow of bile, it may be as- 
sumed that the intestinal secretions in general are promoted by it. 
These effects, which indeed are produced by all the purgatives contain- 
ing a resin, are probably due to phaeoretin — the rhubarb resim 

The coloring-matters of rhubarb stain the perspiration, milk, and 
urine, and the milk acquires a bitter taste and purgative properties. 

Therapy. — The infusion of rhubarb is frequently employed as a 
vehicle for the administration of alkalies and mineral acids in sto- 
machic disorders. In small doses, the tincture is an excellent sto- 
machic tonic in dyspepsia with deficient biliary and intestinal secre- 
tions. It is adapted to those of a relaxed habit, and is inadmissible 
when a hyperemia of the mucous membrane exists. 

Rhubarb is a remedy of the greatest utility in the duodenal catarrh, 
and in the catarrh of the biliary ducts with jaundice, as these maladies 
occur in children. The passing of whitish, pasty, or clay-colored stools, 



640 EVACtJANTS. 

while the skin presents an earthy or jaundiced hue, is the indication for 
the use of rhubarb. It is true that the stools will be quickly stained, 
so as to present the bilious character, without any improvement having 
necessarily taken place in the local malady ; but it is also true that 
rhubarb is curative in the conditions above described. In the summer 
diarrhoea of children, no remedy is more generally prescribed. The 
aromatic sirup of rhubarb is a pleasant form in which to administer it. 
In this disorder, especially if the motions are sour, alkalies should be 
prescribed with the rhubarb. Magnesia, chalk, or sodium carbonate, 
may be given with the powder of rhubarb, the fluid extract, or the 
sirup. The following is an excellent formula in these cases : fy Infus. 
rhei, 3 iij ; potassii bicarb., 3 j ; tinct. cinnamomi, 3 ij ; syrp. simplicis, 
3 vj. M. Sig. : A teasp>oonful every hour or two in cholera infan- 
tum. Diarrhoea in children or adults, due to the presence of undi- 
gested food, or retained irritating secretions, may not unfrequently be 
cured by a purgative dose of some rhubarb preparation. After the 
purgative effect is expended, the bowels are confined by the astringent. 
In acute dysentery the saline purgatives are much more appropriate 
than rhubarb. 

In habitual constipation good effects may be obtained by chewing 
some rhubarb-root. The astringent after-effect is, however, a decided 
objection to the frequent use of this remedy for this purpose. In the 
rhubarb-pill the astringency is counteracted by soap. The compound 
rhubarb-pill, which contains aloes, is a mild and efficient cathartic. 

Aloe. — Aloes. The inspissated juice of the leaves of Aloe Socotrina 
Lamarck (Nat. Ord. Liliaceai). 

Aloe Purificata. — Purified aloes. In brittle pieces of a dull-brown 
or reddish-brown color, and having the peculiar aromatic odor of Soco- 
trine aloes. It is almost entirely soluble in alcohol. (IT. S. P.) Dose, 
gr. j— grs. v. 

PJxtractum Aloes Aquosum. — Watery extract of aloes. Dose, gr. 
ss — gr. v. 

Pilulm Aloes. — Pills of aloes. Each pill contains two grains of 
aloes and two grains of soap. Dose, 1 — 5 pills. 

Pilulm Aloes et Asafcetida3. — Pills of aloes and asafcetidae. (Aloes, 
asafoetidae, and soap, in equal parts.) Dose, 2 — 5 pills. 

Pilulm Aloes et Mastiches. — Pills of aloes and mastic. Lady Web- 
ster's pills. (Aloes, mastic, and red rose.) Dose, 1 — 2 pills. 

Pilulm Aloes et Myrrhw. — Pills of aloes and myrrh. (Aromatic 
powder, myrrh, aloes.) Dose, grs. v — grs. xv. 

Tinctura Aloes. — Tincture of aloes. Dose, 3 ss — 1 j. 

Tinctura Aloes et Myrrhm. — Tincture of aloes and myrrh. Dose, 
3 ss— 3 ij. 

Vinum Aloes. — Wine of aloes. Dose, 3 j — ? ss. 



CATHARTICS. 641 

Pulvis Aloes et Canellce. — Powder of aloes and canella (hiera 
picra). Dose, grs. v — 3], (Not official.) 

Composition. — The odor of aloes is due to a peculiar volatile oil. 
It contains also a resin, and a principle, alo'ine. The composition of 
aloine is not precisely the same in the different varieties of aloes. The 
Barbadoes aloes furnishes barbaloine, the Natal aloes, natalo'lne, and 
the Socotrine aloes, soalo'lne. These varieties, it is supposed, consti- 
tute an homologous series. 

Actions and Uses. — Aloes has a bitter and very disagreeable taste, 
leaving a rather acrid after-sensation in the fauces. It is a stomachic 
tonic, and, like bitters in general, it promotes the appetite and diges- 
tion. Accordingly, it is much prescribed as a stomachic tonic in cases 
of indigestion with torpor of the large intestine. Irritable or inflam- 
matory states of the stomach mucous membrane contraindicate its 
employment. 

The recent investigations of Rutherford and Vignal have shown 
that aloes has the power to stimulate the hepatic functions, and to 
promote the flow of bile. This result is confirmatory of clinical expe- 
rience. In large doses (twenty grains or more) aloes undoubtedly in- 
creases the intestinal secretkms generally ; but, in the ordinary medici- 
nal laxative dose, the stools are not liquid, and are but little altered 
in character. The principal effect of aloes is expended on the large 
intestine, the peristaltic movement of which it increases. Some tor- 
mina is experienced when the laxative effect begins, and tenesmus, 
with heat and irritation of the rectum, is produced when an active 
purgative dose has been taken. The blood -supply to the pelvic 
organs is increased by aloes ; the menstrual flow becomes more 
abundant, and abortion, it is said, may be caused by its incautious 
administration ; while in the male, erections take place more fre- 
quently. 

Ten or twelve hours elapse after it has been swallowed, before 
cathartic effects are produced. The rate at which it moves to affect 
the intestinal canal is influenced less by the size of the dose than by 
the condition of the bowels. 

The purgative principle of aloes diffuses into the blood. Applied 
to an exposed surface, it is absorbed and purges, and the milk of moth- 
ers taking it acquires a purgative action. 

Simple jaundice, of an atonic kind, may be cured by aloes. No 
purgative is more efficient in constipation, dependent on weakness and 
impaired contractility of the muscular layer of the large intestine. 
Jaundice, or at least a bilious state, a coated tongue, foul breath, a 
tumid abdomen, and an impacted colon, are conditions frequently 
associated and are readily relieved by aloes. The constipation of 
hypochondriasis and melancholia is best overcome by the use of this 
agent, and, with the removal of the impacted fasces, there is not un- 
41 



642 EVACUANTS. 

frequently an improvement in the mental state. Aloes is prescribed 
in cerebral disorders, when purgatives are given with a view to a 
derivative effect. 

In amenorrhcea which is dependent on anaemia, aloes is prescribed, 
with other appropriate remedies, to determine an afflux of blood to the 
uterine system. Menorrhagia, occurring in debilitated and relaxed 
subjects, is sometimes relieved in the same way. Iron may be asso- 
ciated with aloes in these cases. Congestion of the pelvic viscera is a 
contraindication to the use of aloes, and the existence of haemorrhoids, 
or of a tendency therefor, has heretofore been considered an equally 
positive contraindication. Fordyce Barker has, however, shown that 
aloes has a curative power in certain cases of hemorrhoids, and nota- 
bly those which occur after delivery. The local condition, under these 
circumstances, is not one of active hyperemia, but really consists in a 
sluggish state of the circulation in the inferior haemorrhoidal veins. 
It can hardly be doubted that aloes would increase the trouble if pre- 
scribed for cases in which there was active congestion of the pelvic 
viscera. Barker also advocates the use of aloes in non-puerperal 
haemorrhoids, but the local condition must be suitable for the use of 
this remedy or the disease will be aggravated. The following are for- 
mulae proposed by Barker: ^ Pulv. aloes Soc, sapo. Cast., aa 3j ; 
ext. hyoscyami, 3 ss ; pulv. ipecacuanhae, grs. v. M. Ft. pil. no. xx. 
Sig. : One pill morning and evening. When the haemorrhoids are 
associated with an irritable rectum, and with frequent, small, teasing, 
thin evacuations, Barker substitutes for the hyoscyamus a small quan- 
tity of opium, giving also a less quantity of the aloes, as in the fol- 
lowing formula : fy Ferri sulph., 3] ; pulv. aloes Soc, ext. opii aq., 
sapo. Cast., aa grs. x. M. Ft. pil. no. xx. Sig. : One pill morning 
and evening. Oppolzer also used aloes as a remedy for haemorrhoids, 
prescribing, when there was constipation, aloes and quinine, and, when 
the bowels were not confined, aloes and sulphate of iron. 

The action of aloes, as well as of other resin-bearing purgatives, in 
the condition of anaemia, is promoted by the conjoined use of the bit- 
ters, quinine, iron, and tonics generally. Two grains of aloes, taken at 
bedtime, will cause a satisfactory evacuation on the following day. 
Combination with soap, as in the official pil. aloes, and pil. aloes et 
asafcetidae, diminishes the drastic, while it increases the efficiency of 
the purgative, action. It is generally better to give aloes by itself, 
without combination with other cathartics ; but its purgative effects 
may be greatly enhanced by administering a saline laxative six or eight 
hours after the aloes has been taken. 

A gonorrhoea may, it is said, be cured by the internal use, three 
times a day, of a pill containing two or three grains of aloes. Catarrh 
of the uterus has been treated successfully by aloes rectal enemata. 
The tincture of aloes, diluted to one half or even more, by water, is a 



CATHARTICS. 643 

very effective injection in gonorrhoea after the acute symptoms have 
subsided. 

Jalapa. — Jalap. The tuber of Exogonium purga Bentham (Nat. 
Ord. Convolvulacece). Racine de jalap, Fr. ; Jalape, Ger. 

Abstractum Jalapw. — Abstract of jalap. Dose, gr. j — gr. v. 

Resina Jalapce. — Resin of jalap. Dose, grs. ij — grs. v. 

JPulvis Jalapce Compositus. — Compound powder of jalap. (Jalap, 
one part ; bitart. of potassa, two parts.) Dose, gr. x — 3 j. 

Composition. — Jalap contains a resin, to which its purgative prop- 
erty is due. The resin consists of two varieties, one soluble, the other 
insoluble, in ether. The latter has been named convolvulin, or jalap- 
in, and is the more active purgative of the two. Various secondary 
products of considerable interest are obtained from the resin, but these 
possess no special importance from the therapeutical point of view. 

Physiological Actions. — As a cathartic jalap resembles, but it is 
much more active than, senna. It is apt to produce nausea, and tor- 
mina and tenesmus invariably accompany its purgative action. It 
usually operates in from two to four hours, but the rate at which it 
moves to affect the intestinal canal is not influenced by the amount 
administered. The stools are soft at first, and afterward liquid. Jalap 
does not produce haemorrhoids, nor does it cause a tendency to, or 
increase an existing, menorrhagia. The secretions of the intestinal 
canal are increased by it, and the recent researches of Rutherford and 
Yignal have demonstrated that jalapin (convolvulin) excites the flow 
of bile. 

The action of jalap appears to be local. It is true that experiments 
in support of a contrary opinion have been made ; but, in the conclu- 
sive test of the intra-venous injection of convolvulin, no purgative 
action has followed (Husemann). 

Therapy. — The resin of jalap being the active constituent, it should 
generally be preferred. It has the merit of being almost tasteless, and 
hence may be given readily to children. 

Jalap is an efficient cathartic in the beginning of fevers, inflamma- 
tions, and acute diseases requiring the use of such therapeutic means. 
Formerly calomel and jalap were much prescribed, but this combina- 
tion has deservedly fallen into discredit. Occasionally the resin and 
calomel, in less ponderous doses than formerly given, may be used with 
advantage as a cathartic : I£ Resinse jalapse, hydrarg. chlor. mit., ext. 
hyoscyami, aa gr. j. M. Ft. pil. no. j. Sig. : Take at bedtime. 

As jalap in sufficient quantity causes free watery evacuations, it is 
a suitable purgative in anasarca and ascites. The most generally ap- 
proved hydragogue purgative, under these circumstances, is the com- 
pound jalap-powder. The efficiency of this may be increased by the 
addition of podophyllum. A teaspoonful of the compound powder, 



644 EYACUANTS. 

taken in the early morning, will usually produce several very copious, 
watery stools. Increased urinary discharge also is a not unfrequent 
result of its action. 

Jalap has the power to cause the expulsion of lumbrici. As a ver- 
mifuge it is not at all equal to the other approved remedies, but it is 
certainly useful as an adjunct. For example, santonin at night, and 
the resin of jalap and calomel on the following morning, is an effective 
method of expelling these parasites. 

Jalap is, of course, contraindicated in inflammatory states of the 
intestinal canal. In overdoses it causes hypercatharsis, and it may 
excite violent gastro-enteritis and endanger life. With proper atten- 
tion to the conditions in which it is admissible, and to the dosage, jalap 
is entirely safe, and is a very certain and efficient cathartic, ^n ex- 
cellent vehicle for the administration of the resin of jalap is the sirup 
of rhubarb. I£ Resinae jalapse, grs. ij — grs. v ; syr. rhei aromat., § ss. 
M. This is especially suitable for children. 

Scammonium. — Scammony. A resinous exudation from the root of 
Convolvulus scammonia Linne (Nat. Ord. Convolvulacece). (IT. S. P.) 
Scammonee, Fr. ; Scammonium, Ger. 

JResina Scammonii. — Resin of scammony. Dose, grs. v — grs. x. 

Composition. — The activity of scammony, as a cathartic, depends 
entirely on the resin which it contains. As the crude scammony is 
much adulterated, the resin is alone worthy of confidence. 

Actions and Uses. — Scammony corresponds very closely to jalap 
in the time it requires to cause cathartic action, in the character of the 
stools produced, and in the kind of irritation which it excites. Scam- 
mony is somewhat more drastic than jalap. As it has but little taste, 
and is at the same time very active, the resin is much prescribed by 
English practitioners as a cathartic for children. It may be given 
rubbed up with milk, or with sirup of rhubarb. It is adapted to the 
same class of cases, and to the relief of the same conditions, as jalap. 

Colocynthis. — Colocynth. The fruit, deprived of its rind, of Citrul- 
lus colocynthis Schrader (Nat. Ord. Cucurbit acece). (IT. S. P.) Co- 
loquinte, Fr. ; Ebloquinten, Ger. 

Extractum Colocynthidis. — Extract of colocynth. 

Extractum Colocynthidis Compositum. — Compound extract of colo- 
cynth. (Extracts of colocynth, scammony, and aloes ; cardamoms, 
soap.) Dose, grs. v — grs. x. 

Pilulce Catharticce Compositm. — Compound cathartic pills. (Com- 
pound extract of colocynth, abstract of jalap, calomel, gamboge.) 
Dose, 1 — 3 pills. Each pill contains one grain of calomel. 

Composition. — Colocynth contains a bitter principle {colocynthiri), 
which is the purgative principle. Colocynthitin is another substance 



CATHARTICS. 645 

contained in the alcoholic extract. It differs from colocynthin in being 
soluble in ether, and not in water. As colocynthitin is a tasteless crys- 
talline powder, it is probably devoid of purgative property. Colocyn- 
thin is a very powerful cathartic. 

Actions and Uses. — Colocynth is a gastro-intestinal irritant. In 
moderate doses it hastens the peristaltic movements, and increases the 
intestinal secretions. Its cathartic operation is usually attended with 
griping, and the stools are fluid. Violent gastro-enteritis may be pro- 
duced by a large quantity, and numerous fatal cases have been reported 
from its incautious or criminal administration. 

The action of colocynth is not merely local. Applied to the skin 
of the abdomen, it causes intestinal pain, and more frequent alvine dis- 
charges. 

Colocynth is never administered alone, but usually in combination 
with other purgatives. The compound extract is a safe, effective, and 
not unpleasant cathartic for the relief of constipation. 1$, Ext. colo- 
cynthidis comp., 3j ; ext. belladonna?, ext. physostigmatis, aa grs. v. 
M. Ft. pil. no. x. Sig. : One each night in habitual constipation. 
The official compound cathartic pill is a most serviceable combination. 
Instead of calomel the resin of podophyllum may be used in the prepa- 
ration of this pill, without impairing its utility. 

In cerebral congestion the preparations of colocynth are used as 
derivative purgatives. Hypochondriasis and melancholia, when asso- 
ciated with torpor of the large intestines and fecal accumulations, are 
benefited by brisk purging with the colocynth preparations, but other 
drastic purgatives are equally efficient. 

Colocynth is inadmissible in inflammatory states of the intestinal 
canal, and is unsafe during the existence of pregnancy. There is a 
popular notion, which has led to its use in toxic doses, that colocynth 
may cause abortion. Any quantity which will affect the gravid womb 
must be sufficient to endanger life. 

Podophyllum. — May-apple. The rhizoma and rootlets of Podo- 
phyllum peltatum Linne (Nat. Ord. Berber idaceai) . (IT. S. P.) 

JResina Podophylli. — Resin of podophyllum. Dose, gr. \ — gr. j. 

Extractum Podophylli. — Extract of podophyllum. Dose, grs. v 
— grs. x. 

Abstraction Podophylli. — Abstract of podophyllum. Dose, gr. \ 

— g r - J- 

Extractum Podophylli Fluidum. — Fluid extract of podophyllum. 
Dose, m, j — 3 ss. 

Composition. — The medicinal qualities of podophyllum are due to 
a resin, or to two resinous substances, one soluble in alcohol and ether, 
and the other soluble in alcohol only. Both possess purgative proper- 
ties. May-apple-root contains the alkaloid berberine, which, however, 



646 EVACUANTS. 

is not peculiar to podophyllum, being found in berberis, hydrastis, and 
other plants. 

Resina podophylli is the preparation entitled " podophylliD " by the 
eclectic practitioners. 

Actions and Uses. — The taste of podophyllum, is bitter, with an 
after-sense of acridity. It increases the intestinal secretions, and is 
actively cathartic, producing copious and rather watery stools. Its 
action is similar to, but considerably slower than, that of jalap. From 
six to ten hours elapse after its administration before cathartic effects 
are experienced. Taken by itself, it is apt to cause nausea and griping, 
but in combination with other cathartics, or with belladonna or hyos- 
cyamus, it operates pleasantly as well as efficiently. The Edinburgh 
committee, Dr. Bennett, chairman, ascertained, as they supposed, that 
the resin of podophyllum has no cholagogue action, but the more re- 
cent as well as the more accurately conducted experiments of Ruther- 
ford and Vignal have apparently demonstrated that it decidedly in- 
creases the flow of bile, corresponding in this particular to the other 
resinous cathartics. 

Podophyllum-resin is the most generally useful cathartic in cases 
of constipation, in which the secretions of the glandular apparatus of 
the intestinal canal, and of the liver, are deficient. Habitual constipa- 
tion, due to torpor of the muscular layer of the bowel, may, it is said, 
be removed by the nightly use of a small dose of the resin combined 
with belladonna. $ Resinae podophylli, grs. vj ; ext. belladonnae, ext. 
physostigmatis, aa grs. iij. M. Ft. pil. no. xij. Sig. : One pill each 
night. It is especially in congestion of the portal circulation, in catar- 
rhal and malarial jaundice, and in ascites, that podophyllum-resin acts 
most efficiently and serviceably. Haemorrhoids that bleed in conse- 
quence of stasis in the portal circulation, and that are of recent forma- 
tion, may sometimes be cured by a brisk podophyllum cathartic. 

The clinical experience which had shown that the resin of podo- 
phyllum possessed cholagogue powers, long before the experimental 
inquiry was instituted to settle the question, led also to a wide gener- 
alization in the therapeutical uses of this agent. Acting on the liver, 
it was assumed that, in a manner similar to mercury, it must also pos- 
sess similar " alterative " powers. It came to be used as the " vege- 
table calomel," in the diseases in the treatment of which mercury was 
supposed to be essential. It need hardly be asserted that these specu- 
lations have no basis, and that podophyllum possesses no property in 
common with mercury except its power to purge. 

Leptandra. — Leptandra. The rhizoma and rootlets of Leptandra 
Virginica Nuttall (Nat. Ord. Scrophulariacem). (II. S. P.) 

Extr actum Leptandra^. — Extract of leptandra. Dose, gr. ij — 
gr. x. 



CATHARTICS. 647 

Extractum Leptandrm Fluidum. — Fluid extract of leptandra. 
Dose, in, v — 3 j. 

Composition. — A crystallizable principle has been obtained from 
the root — leptandrin (?). It contains also a resin which, in the impure 
form at present found in commerce, has a distinctly purgative quality 
and is known as leptandrin. The dose of this preparation is gr. ij — 
gr. v. 

Actions and Uses. — Leptandra is an active cathartic in the recent 
state. In the form of the fluid extract, or of the so-called leptandrin, 
it acts mildly, causing somewhat liquid and apparently bilious stools. 
It is held to be cholagogue, and, according to the rules of analogy, this 
claim may be well founded, for other cathartics containing resin, as 
the experiments of Rutherford and Yignal have shown, possess the 
power to increase the flow of bile. 

It is applicable to cases of disease of the intestinal canal, attended 
by constipation, in which the biliary and intestinal secretions are in- 
sufficient. 

Iris. — Blue flag. The rhizoma and rootlets of Iris versicolor Linne 
(Nat. Ord. Iridacem). (IT. S. P.) 

Extractum Iridis. — Extract of iris. Dose, gr. j — gr. v. 

Extractum Iridis Fluidum. — Fluid extract of iris. Dose, v\ v 
-3j. 

Under the name iridi?i, there is to be found in the shops a "resi- 
noid," having more or less of the properties of the crude drug. The 
dose of this preparation is from one to five grains. 

Actions and Uses. — Iris versicolor has a bitter, nauseous, and 
rather acrid taste. It is apt to cause severe nausea. The fresh root 
has actively purgative and diuretic qualities, but these are impaired 
by age. The fluid extract and the " iridin " are laxative, and are sup- 
posed to have cholagogue powers. 

The oleo-resin is prescribed in hepatic and intestinal disorders, and 
in dropsy. There is much evidence tending to show that this remedy 
is really serviceable when the stools are clay-colored, and the skin 
jaundiced, in consequence of duodenal catarrh and obstruction of the 
biliary ducts. It is said that malarial jaundice may be cured by this 
drug, and that in bilious remittent fever and in chronic malarial poi- 
soning it exerts a favorable influence. 

EuonymuS. — Wahoo. The bark of Euonymus atropurpureus Jac- 
quin (Nat. Ord. Celastracew). (U. S. P.) 

Extractum Euonymi. — Extract of enonymus. Dose, gr. j — gr. v. 

The eclectic preparation (euonymin) consists of the resin and fixed 
oil, and is prescribed in the dose of a half -grain to five grains. 

Composition. — An uncrystallizable and intensely bitter principle 



648 EVACUANTS. 

has been isolated (euonymin). It contains also a crystallizable, a yel- 
low and a brown resin, fixed oil, etc. 

Actions and Uses. — Euonymus possesses cathartic properties simi- 
lar to rhubarb, but is much milder, and is an excellent remedy in 
hepatic and intestinal disorders requiring the use of such an agent. 
The eclectic preparation (euonymin) is a convenient form in which 
to procure the cathartic action of euonymus. Rutherford has shown 
that it is a highly efficient cholagogue. 

Baptisia. — Wild indigo. The root-bark of Baptisia tinctoria. (Not 
official.) Preparations corresponding to those of iris and euonymus 
can be obtained. 

Extr actum JBaplisice. — Extract of baptisia. Dose, gr. j — gr. x. 

Baptisin, the resinoid, is much prescribed by eclectic practition- 
ers. The dose is one to five grains. 

Actions and Uses. — The taste of baptisia is bitter and somewhat 
acrid. It increases the secretions of the glandular appendages of the 
gastro-intestinal mucous membrane. It possesses in large doses emeto- 
cathartic property, and may indeed excite violent gastro-intestinal in- 
flammation ; in small doses it is merely laxative. The resinoid baptisin, 
so called, has been studied by Rutherford, who found it to possess ac- 
tive cholagogue property. Given to dogs, it distinctly stimulates the 
hepatic functions and increases the production of bile. It is probable 
that it deserves to rank among the most efficient of the remedies of 
this group. It is indicated, therefore, in all the cases in which hepatic 
stimulants are desirable. 

HYDKAGOGUE CATHARTICS. 

Cambogia. — Gamboge. A gum-resin obtained from the Garcinia 
Hanburii Hooker filius (Nat. Ord. Guttiferw). (U. S. P.) Gomme- 
gutte, Fr. ; Gummigutt, Ger. Dose, gr. j — grs. v. 

The only official preparation is the compound cathartic pill, of 
which gamboge constitutes about a tenth part. 

Composition. — Gamboge is a mixture of resin and gum, the latter 
constituting from fifteen to twenty per cent. 

Actions and Uses. — Gamboge has no taste at first, but, when 
chewed, an acrid sensation is developed in the mouth. It is irritant to 
the gastro-intestinal canal, increases secretion of the glands, excites 
vomiting and intestinal pain, and purges violently, producing copious 
watery stools. The experiments of Rutherford and Vignal show that 
gamboge is not an hepatic stimulant, but does cause hydro catharsis. 
Violent gastro-enteritis is set up by large doses, yet but few fatal cases 
have been reported. As vomiting soon follows the ingestion of a large 
dose, this fact may explain the rarity of a fatal result due to its ad- 
ministration. 



CATHAKTICS. G49 

Gamboge is rarely prescribed alone as a cathartic, owing to the vio- 
lence and harshness of its operation. Combination with other cathar- 
tics, as in the compound cathartic pill, greatly modifies its action. As 
it is a powerful hydragogue cathartic, it is given with advantage in 
dropsy, when hydrocatharsis is indicated. It is best administered in 
small doses, at short intervals, rubbed up with sugar or made into a 
pill with soap. Besides its purgative properties, gamboge is decidedly 
diuretic. In order to obtain its diuretic effects it must be given in 
small doses, at short intervals, and vomiting must be avoided. Admin- 
istered in solution with an alkaline diuretic, its efficiency is much in- 
creased. Gamboge has also been used as an anthelmintic, but it has no 
powers in this respect not possessed by other drastic purgatives. 

Oleum Tiglii. — Croton-oil. A fixed oil expressed from the seeds 
of Croton tiglium Linne (Nat. Ord. Euphorbiaceoe). (U. S. P.) 
Huile cle Croton, Fr. ; Crotonol, Ger. Dose, gt. j — gtt. ij. 

Composition. — It contains glycerides of the fatty acid series— 
stearic, palmitic, myristic, and lauric acids — and the more volatile acids, 
acetic, butyric, and valerianic (Fltickiger and Hanbury, Husemann). 
Genther and Frohlic have discovered a peculiar volatile acid, to which 
they have applied the name tiglinic acid. By the same chemists the 
so-called crotonic acid is held to be an artificial product. Schlippe 
has asserted the discovery of the vesicating principle of croton-oil, but 
other chemists have failed to find this substance, to which he has as- 
signed the name of crotonol. The purgative principle of the oil ap- 
pears to exist in all parts of the Croton tiglium, but it has not yet been 
isolated. 

Actions and Uses. — Croton-oil is a transparent or semitransparent 
viscid liquid, amber-colored, and having a rather rancid smell, and an 
oily, acrid taste. Applied by friction to the skin, it excites inflamma- 
tion, and causes an eruption which is at first papular, with rounded 
summits, and afterward becoming pustular. The eruption is sometimes 
umbilicated, but is generally rounded. An areola surrounds the pus- 
tules, and there are considerable heat and burning in the part. The 
eruption appears in a few hours after the frictions have been practiced, 
reaches its maximum in about four days, and then declines by abortion 
of the pustules and by scabbing. In many subjects permanent, small 
white cicatrices mark the site of the eruption. All subjects are not 
equally susceptible to the vesicating action of croton-oil. 

The mucous membrane is violently attacked by croton-oil. In the 
fauces it causes an intensely acrid sensation, and increases the flow of 
saliva. A sense of heat, pain, and nausea is produced when the oil 
is received into the stomach, tormina soon follows, and in an hour or 
two watery stools are passed with some burning and irritation about 
the anus. The action of the oil continues during the succeeding twelve 



650 EVACUANTS. 

to twenty-four hours, numerous fluid dejections are passed, and con- 
siderable debility is the result. When large doses are taken, if not 
rejected promptly by vomiting, violent hypercatharsis occurs with 
great prostration and collapse. Fortunately, when an overdose is 
swallowed, vomiting quickly ensues, and hence very large quantities 
have been taken without producing a fatal result. The lesions caused 
by croton-oil are those of gastro-enteritis, but fatal cases have occurred, 
with all the objective phenomena of choleraic collapse, without any 
evidences of local inflammation. 

As croton-oil is still purgative after being deprived of its acrid 
principle by washing with alcohol, it has been held that the oil be- 
comes cathartic only by the action of the alkaline juices of the duo- 
denum. [Numerous instances have been reported, and some have fallen 
under the author's observation, in which croton-oil applied to the 
integument has produced diarrhoea. It must, therefore, act by absorp- 
tion into the blood. In some cases, without causing purging, croton- 
oil affects the nervous system in a peculiar manner. Thus restless- 
ness, palpitation of the heart, headache, giddiness, confusion of ideas, 
etc., have occurred under these circumstances (Husemann). 

Rohrig found that croton-oil stimulated the hepatic function, and 
increased the flow of bile. Radziejewski found peptones, bile, gly- 
cogen, leucin, and tyrosin, in the stools. Rutherford and Yignal have 
since shown that croton-oil, although it causes great vascular dilatation 
of the vessels of the intestinal mucous membrane, can not be regarded 
as a cholagogue. 

The principal effect of croton-oil, for which it is administered in 
medical practice, is that of a hydragogue cathartic. It is, therefore, 
used in dropsies when it is desired to procure free, watery evacuations. 
It is inadmissible when there is much debility, or when an irritable or 
inflammatory state of the intestinal mucous membrane exists. 

Notwithstanding its great activity, croton-oil is an easily-managed 
cathartic for ordinary purposes. It is the most efficient purgative when 
there is simple impaction, without inflammatory symptoms. The con- 
stipat ion from lead may be overcome by it, when less powerful purga- 
tives will fail. It is the most appropriate of cathartics, when these 
agents are indicated as revulsives in cerebral congestion. Croton-oil, by 
increasing the vascular dilatation in the intestines, lowers the intra- 
cranial blood-pressure. Per contra, it is harmful when a state of cere- 
bral anaemia exists. 

Croton-oil has been used successfully against tcenia, but it has no 
special vermifuge property. 

The smallness of the dose required renders croton-oil a very useful 
purgative in the maladies of children and of the insane. When the 
patient is unable to swallow from insensibility or paralysis, a drop or 
two placed on the tongue will act efficiently. It may be given to chil- 



CATHARTICS. 651 

dren, rubbed up with sugar of milk. As washing with alcohol removes 
the acridity, and does not impair the purgative property, a preparation 
so treated will be best for administration to children. The unpleasant 
effects of this remedy may be much modified by combination with 
other cathartics. I> 01. tiglii, gtt. iij ; ext. colocynth. com., 3] ; ext. 
belladonnse, grs. iij. M. Ft. pil. no. vj. One of these will usually 
act efficiently. The following is the formula of Dr. Francis's " triplex 
pills " : P> Aloes socot., scammonii, pil. hydrargyri, aa ^ j ; ol. tiglii, 
V], xx ; ol. carui, in, xc ; elix. proprietatis, q. s. M. Ft. pil. no. 400. 
Dose, as a laxative, one at bedtime. This combination is very popular 
in New York. 

Elaterium. — Elaterium. A substance deposited by the juice of the 
fruit of Momordica elaterium, Ecbalium agreste. (Not official.) Con- 
combre purgatif, Fr. ; Springgurhe, Ger. Dose, gr. -^ — gr. \. 

Composition. — The important constituent of elaterium is elaterin. 
Owing to the uncertainty in the strength of elaterium, it has been 
omitted from the official list, and its active constituent substituted. 

Elaterinum. — Elaterin. A neutral principle extracted from elate- 
rium, a substance deposited by the juice of the fruit of Ecbalium ela- 
terium A. Richard (Nat. Ord. Cucurbit aceaz). (IT. S. P.) 

Small, colorless, shining hexagonal scales or prisms, permanent in 
the air, odorless, having a bitter, somewhat acrid taste, and a neutral 
reaction. Insoluble in water ; soluble in 125 parts of alcohol at 60° 
Fahr. Dose, gr. ^ — gr. £. 

Trituratio Elaterini. — Trituration of elaterin. (Elaterin, 10 parts ; 
sugar of milk, 90 parts.) Dose, gr. ss — gr. ij. 

Actions and Uses. — Elaterium excites an abundant flow of saliva, 
and a persistent bitter taste is experienced in the fauces some time 
after it is swallowed. Nausea and vomiting, profuse, watery stools, 
and great weakness and prostration, are produced by a considerable 
dose of elaterium. The vomited matters and stools have an appearance 
and composition similar to the "rice-water " discharges of cholera. On 
animals elaterium acts somewhat differently. Without causing purg- 
ing, it affects the nervous system, producing irregular respiration, 
hebetude, convulsions, and death (Kohler). The gastro - intestinal 
action is doubtless local, and the result of the immediate impression 
made by the agent in its passage down the intestinal canal. Ac- 
cording to Kohler, the presence of bile is necessary to the action of 
elaterium. 

The chief use of elaterium is to procure free watery evacuations in 
ascites, general dropsy, urcemia, and to act as a revulsive in cerebral 
disorders. It must be used with caution in debilitated subjects. Gas- 
trointestinal irritation, or inflammation, contraindicates its use. The 



652 EYACUANTS. 

depression which its operation induces must be counteracted by stimu- 
lants and proper aliment. 

Authorities referred to : 

Anstie, Dr. F. E. Report on the Physiological Action of Podophyllin. Tlie Medical 
Times and Gazette, vol. i, 1863. 

Barker, Dr. Fordyce. The Puerperal Diseases, p. 34. 

Brunton, Dr. T. Lauder. On the Action of Purgative Medicines. TJie Practitioner, 
May, 1874. 

Fluckiger and Hanbury. Pharmacographia. Various articles. 

Husemann, Drs. Aug. und Theo. Die Pfanzenstofe. 

Husemann, Dr. Theo. Handbuch der gesammten Arzneimittellehre, zweiter Band. 

Kohler, Dr. H. Der Fruchtsaft von Momordica Elaterium in historischer, chemi- 
scher und physiologischer Hinsicht. Virchow's Archiv, Band xlix, p. 434, 1, p. 273. 

Moreau, Armand, Dr. Archives Genet-ales de Med., vol. xvi, p. 234, sixth series. 

Percy, Dr. S. R. The American Medical Times, vol. iv. 

Radziejewski, Dr. S. Schmidt's Jahrbucher, vol. cxlvii, p. 20. Zur physiolog. Wirk- 
ung der AbfiXhrmittel. 

Rutherford and Yignal. Experiments on the Biliary Secretion of the Dog. TJie 
British Medical Journal, November, 1875. 

Thiry, Dr. L. Schmidt's Jahrbucher, vol. cxxviii, p. 17. 

Vulpian, Prof. A. Bulletin General de Tlierap., vol. Ixxxiv, p. 522. 

Enemata. — An enema is a rectal injection. The capacity of the 
rectum, it need hardly be stated, varies with the age of the individual. 
For an infant, half an ounce to an ounce ; for a child of two to five 
years, two to six ounces ; for five to fifteen years, six ounces to a pint; 
for an adult, a pint to a quart of fluid may be considered as an ap- 
proximation to the capacity of the rectum at these ages respectively. 
Habitual use of injections no doubt increases the tolerance, as also the 
capacity of the rectum. 

Injections may consist of water — cold, tepid, warm, or hot ; of 
medicated solutions — emollient, anodyne, laxative, cathartic, or anthel- 
mintic. Under this head are to be considered only enemata adminis- 
tered with the view to cause an evacuation from the intestinal canal. 

Enemata act either by a reflex irritation or by absorption. When a 
cold injection is thrown into the rectum, or this organ is distended, an 
action is set up for the expulsion of the offending substance, and the 
muscular fiber of the bowel more or less vigorously contracts according 
to its functional condition. The quantity, as well as the temperature 
of the fluid injected, must therefore be taken into consideration, when 
it is proposed to empty the bowels by a merely reflex irritation. On 
the other hand, when it is the intention to procure the absorption of 
the medicated fluid, the quantity injected must be relatively small, and 
its temperature should, as nearly as possible, be that of the rectum. In 
order to secure absorption, it is necessary also to regard the laws of 
diffusion. As the secretions of the rectum are alkaline, it is obvious 
that acidulated solutions will diffuse into the rectal veins with the 



CATHARTICS. 653 

greatest facility. It is doubtful whether colloidal substances of them- 
selves are taken up in the rectum. (See Nutrient Enemata, p. 55.) 

Irrigation of the intestines, or forced injections of a large quantity 
of water, is a modern expedient of great practical utility. The appa- 
ratus required for the performance of this operation consists of a rectal 
tube, a flexible rubber pipe three or four feet in length, and a funnel- 
shaped vessel to contain the fluid to be injected. The decubitus on 
either side, the hips being elevated, may be sufficient ; but, to insure 
gravitation of the fluid to the ileo-ca?cal valve, the female patient 
should be placed in Sims's position, and the male patient on his hands 
and knees. The rectal tube should be inserted, and passed up to the 
sigmoid flexure ; the flexible tube should then be attached. The 
height to which the reservoir is raised will regulate the hydrostatic 
pressure, and the flow of fluid through the flexible tube can be lessened 
or increased at the pleasure of the operator by compression with the 
fingers. 

In administering rectal injections the utmost gentleness is requisite, 
especially when a large amount of fluid is to be introduced. Rude 
thrusting of the pipe into the rectum may injure the mucous mem- 
brane, and rapid and forcible dilatation of the bowel will excite an 
imperious desire to go to stool. Too great pressure, in the process of 
irrigation, may cause a rupture of the intestine, especially if its coats 
are softened by disease or penetrated by ulceration. It is possible 
that sudden and forcible distention of the bowel may produce dan- 
gerous cardiac syncope in susceptible subjects. 

The experiments on the cadaver have demonstrated that, although 
the large intestine may be filled with water, no fluid can be made to 
pass the ileo-csecal valve. Notwithstanding these experiments, it has 
been claimed that in the living subject, by the irrigation method, water 
can be forced through the whole length of the intestine. If these ob- 
servations are correct, it is probable that a pathological state of the 
ileo-csecal valve must have existed. 

Forms of Enemata. — Enema Aloes. — $ Aloes, 3ij ; potassii car- 
bonat., grs. xv ; mucil. amyli vel decoct, hordei, | x. (B. P.) 

Enema Magnesii Sulphatis. — fy Magnesii sulphat., § j ; ol. olivse, 
f j ; mucil. amyli vel decoct, hordei, § xv. Dissolve the sulphate of 
magnesia in the mucilage, then add the oil. (B. P.) 

Enema Terebinthince. — ^ 01. terebinthinse, 3 j ; mucil. amyli vel 
decoct, hordei, J xv. (B. P.) 

Enema 01. JRicini et Terebinthinw. — fy 01. terebinthini, 3 ss ; ol. 
ricini, | jss ; ovi, j ; decoct, hordei vel aq. fervid., § xiv. 

A common domestic enema consists of soap-suds, made somewhat 
more stimulating to the rectum by the addition of turpentine. 

Therapy. — A pint of cold water is a good enema for cases of 
habitual constipation, especially when there are haemorrhoids which 



654 EVACUANTS. 

bleed with every motion. The enema of aloes, in quantity correspond- 
ing to the age of the subject, is an efficient remedy for the destruction 
of ascarides vermicular 'es. 

The purgative enemata above given are employed to act on the 
large intestine, chiefly by virtue of reflex stimulation, but, in part, ab- 
sorption of the purgative principle takes place, whence it follows that 
they may affect the whole canal. They are used, therefore, as cathar- 
tics, and for the ordinary purposes of these remedies. The purgative 
enemata are not suitable for habitual use. They excite irritation of 
the rectum, which may result in ulceration, ischio-rectal abscess, fistula 
in ano, fissure of the anus, and other serious accidents. 

Irrigation of the bowel is resorted to for the removal of impacted 
faices, to overcome intussusception , etc. 

Cases of intestinal invagination have been very quickly relieved by 
sudden inflation of the large intestine with carbonic acid. The process 
consists in the injection of a solution of sodium bicarbonate, followed 
by a solution of tartaric acid — about one drachm of each to eight 
ounces of water. The escape of the gas through the sphincter ani 
must be prevented by forcible pressure upon the anus. 

Suppositoria Aloes. — (Aloes and cacao-butter.) Each suppository 
contains about five grains of purified aloes. One of these, introduced 
into the rectum at night, will generally procure one or two evacua- 
tions on the following day. It is not good practice to employ such a 
method of treatment frequently. 

A piece of hard white soap cut into a conical shape, and of a suit- 
able size, is frequently used in domestic practice to relieve the consti- 
pation of infants. The soap suppository thus prepared is carefully 
introduced into the rectum. The habit of a daily evacuation may be 
thus induced. A piece of paper rolled into a conical shape, and dipped 
into oil, may be used instead of the soap suppository. 



ANTHELMINTICS. 

Anthelmintics are remedial agents used to cause the expulsion of 
parasites from the intestinal canal. Vermifuges are remedies which 
expel worms ; vermicides are remedies which kill as well as expel 
worms. Some of these agents act mechanically, as mucuna and pow- 
dered tin ; others are administered in such quantity as to sicken and 
disable the worms, when their expulsion is easily effected : for ex- 
ample, pumpkin-seed emulsion. Others again possess narcotic and 
toxic properties, as turpentine, chenopodium, santonin, etc. 

Anthelmintics are conveniently divided into those employed against 
ascarides vermiculares, those employed against ascarides lumbricoides, 
and those employed against the different varieties of taenia. 



ANTHELMINTICS. 655 

Ascarides vermicidares infest the rectum and large intestine, ex- 
tending up occasionally as high as the ileo-csecal valve ; in females, 
they may also spread into the vagina. As they deposit their ova in 
the folds of the anus, and in the vagina, it is obvious that the parasiti- 
cide, to be effective, must be applied in these situations. 

Infusion of quassia, decoction of aloes, and a weak solution of car- 
bolic acid, are the most frequently-prescribed remedies for the destruc- 
tion of ascarides. If carbolic acid is used, the strength of the injec- 
tion for children should not exceed ten grains to the pint, and it 
should not be retained. Infusion of quassia is at the same time safe 
and effective ; but, when this injection is used, a solution of carbolic 
acid should be applied also, by means of a sponge, to the folds of the 
anus, and, in the case of female children, to the external genitals. If 
the ascarides extend up into the large intestine beyond the sigmoid 
flexure, a dose of santonin and calomel should precede the use of the 
rectal parasiticide. 

REMEDIES USED FOR THE EXPULSION OF ASCARIDES LUMBRICOIDES. 

Muctma. — Cowhage. The hairs of the pods of Mucuna pruriens. 
This remedy is now rarely if ever used. It is administered in the 
form of electuary, mixed with molasses. A teaspoonful or more of 
the mixture should be administered fasting, and after the action of a 
cathartic. When several doses have been taken a brisk purgative 
should be given. 

When cowhage is applied to the skin it excites intense itching, in- 
flammation in the skin, and pustulation. It has been proposed as a 
counter-irritant, but a more disagreeable one could hardly be conceived. 
It is very irritant to the intestinal mucous membrane, as it is to the 
skin, and an action is speedily set up for its expulsion. When by the 
use of a purgative, and by reason of fasting, intestinal worms are un- 
covered and exposed to attack, it is held that the mucuna-hairs pierce 
the parasites and irritate them, so that their stay in the intestine is 
rendered intolerable. In consequence of the active peristaltic move- 
ments induced by the cowhage, and by the purgative with which it is 
followed, the worms are hurried out with the remaining contents, if 
any, of the intestines. 

Santonica. — Santonica. The unexpanded flowers of Artemisia ma- 
ritima, var. Stechmanniana Besser (Nat. Ord. Composite) . (U. S. P.) 
Semencine, Fr. ; Wurmsamen, Ger. 

Composition. — Resin, malic acid, essential oil, and a crystallizable 
principle (santonin). 

Santoninum. — Santonin. A neutral principle obtained from san- 
tonica. A colorless substance, crystallizing in shining, flattened prisms, 



656 EVACUANTS. 

without smell, and nearly tasteless when first put into the mouth, and 
afterward bitter. It is not altered by the air, but becomes yellow on 
exposure to light. Nearly insoluble in cold water, it is dissolved by 
two hundred and fifty parts of boiling water. It is soluble in forty- 
three parts of cold, or in three parts of boiling alcohol, and in seventy- 
five parts of ether. Dose, gr. ss — grs. v, according to age. 

Trochisci Santonini. — Troches of santonin. (Not official.) (San- 
tonin, 1 ss ; with sugar, tragacanth, orange-flower water, to form four 
hundred and eighty troches.) Each troche contains a half-grain of 
santonin. 

Antagonists and Incompatibles. — We do not possess any satis- 
factory data in regard to the physiological antagonists of santonin. 
When a poisonous dose has been taken the stomach should be emptied, 
and the systemic effects should be treated symptomatically. 

Synergists. — Therapeutically the action of santonin is aided by 
cathartics, especially by calomel. 

Physiological Actions. — In ordinary medicinal doses as used for 
the expulsion of lumbrici, santonin causes no sensible intestinal dis- 
turbance. In considerable doses nausea and vomiting are produced, 
and are followed by colic and diarrhoea. Santonin enters the blood, 
probably, in combination with soda, for, although it has no acid prop- 
erties, it has the power to form such combinations. Santonin, ac- 
cording to Hesse (Fltickiger and Hanbury), is the anhydride of a 
crystallizable acid, which, when heated, is resolved into santonin and 
water. Vision is affected in a remarkable manner. Usually all objects 
appear as if viewed through yellow glass ; but other colors sometimes 
appear, as green, blue, or even red ( Gelbsehen, Rose). The chroma- 
topsia is probably due, according to Rose, to the solution of santonin 
in the alkaline serum, and its action on the perceptive centers (vol. 
xviii, page 26). In passing out with the urine santonin imparts a yel- 
lowish, and, when the amount is large, a reddish-purple, hue to this 
fluid. 

In toxic doses santonin produces very decided cerebral effects : 
trembling, vertigo, convulsive movements, tetanoid cramps, stupor, 
cold sweats, dilated pupils, insensibility, etc. 

Therapy. — Cures of amaurosis have been reported from the use 
of santonin, but we possess no exact indications for its administration. 
It is, probably, effective only in functional derangement. The chief 
use of this remedy is for the expulsion of ascarides lumbricoides. It 
is the most effective and pleasant remedy which can be employed for 
this purpose. A convenient form for administration is the troche, or 
it may be prescribed in a powder with calomel. The following is a 
successful plan of using this parasiticide : A laxative in the morning, 
fasting through the day, a dose of santonin and calomel at bedtime, a 
senna-draught on the following morning. 



ANTHELMINTICS. 657 

Authorities referred to : 

Brown, Dr. Dyce. Schmidt's Jahrbucher, vol. cl, p. 138. 
Fluckiger and Hanburt. Pharmacographia, p. 347. 
Hermann, Dr. L. Lehrbuch der exper. Toxikologie, p. 383. 
Husemann, Drs. Aug. tjnd Theod. Die Pflanzenstoffe, p. 927. 
Kohler, Prof. Dr. Hermann. Handbuch, vol. ii, p. 1292. 
Rose, E. Vir chow's Arehiv, vols, xvi, xviii, xix, xx, xxviii. 

Spigelia. — Pink-root. The rhizoma and rootlets of Spigelia Mari- 
landica Linne (Nat. Ord. Loganiacew). (U. S. P.) 

Extractum Spigelian Fluidum. — Fluid extract of spigelia. Dose, 
3j— Iss. 

Composition. — A bitter, uncrystallizable principle (spigelin ?), vol- 
atile oil, tannic and gallic acid. 

Actions and Uses. — In moderate doses spigelia produces a sensa- 
tion of warmth at the epigastrium, stimulates the intestinal movements, 
accelerates the action of the heart, and promotes the cutaneous trans- 
piration. In large doses it causes cerebral effects, vertigo, dimness 
of vision, dilated pupils, convulsions, and insensibility. Many of the 
serious symptoms supposed to have been produced by it in certain 
cases were probably really due to pre-existing cerebral lesions. Cases 
of basilar meningitis, for example, have not unfrequently been con- 
founded with " worm-fever." Any vermifuge, given under these cir- 
cumstances, might seem to have caused the head-symptoms which are 
characteristic of the brain-lesions. 

Spigelia is used only as a vermifuge, and against the round worm, 
for the expulsion of which it has proved to be very efficient. A low 
diet and a brisk cathartic should precede the use of this remedy. The 
best form for administration is the fluid extract of senna and spigelia. 

Authorities referred to : 

Porcher, Dr. F. P. Resources of the Southern Fields and Forests. 
Stille, Dr. Alfred. Therapeutics and Materia Medica. 

Chenopodium. — Worm-seed. The fruit of Chenopodium anthelmin- 
ticum Gray (Nat. Ord. Chenopodiacece). (IT. S. P.) 

Oleum Chenopodii. — Oil of worm-seed. Dose, gtt. v — gtt. xv. 

Actions and Uses. — The oil of worm-seed is the only preparation 
of the plant now used, and this is rarely employed, in consequence of 
its very disagreeable and characteristic odor and taste. It excites a 
sensation of warmth at the epigastrium, increases the action of the 
heart, and promotes cutaneous, bronchial, and renal secretions. It is a 
diffusible stimulant, and as such may be given with advantage in hys- 
teria and chorea, as a carminative in flatulence, and as an antiperiodic 
in inter mittents. The only use of worm-seed is as a remedy for as- 
carides lumbricoides. It is one of the most efficient of the class. It 

42 



658 EVACUANTS. 

should be given three times a day for two days, and followed by a 
brisk cathartic. An excellent combination for the expulsion of the 
round worm is ten drops of worm-seed oil, and a teaspoonful of fluid 
extract of senna and spigelia. It may also be administered in castor-oil. 

REMEDIES USED AGAINST T.ENLE. 

The success of tseniafuges depends largely upon the preliminary 
treatment. The parasite is imbedded in mucus, its hooklets fixed in 
the mucous membrane. The medicament which is administered for its 
expulsion must come in contact with the scolex. To dislodge a quan- 
tity, however large, of the segments (strobila), although temporary 
relief may follow, will not be permanently curative. The head of the 
parasite must be expelled. 

Before using the tseniaf uge the contents of the intestinal canal must 
be thoroughly evacuated. 

Two days of fasting, some milk and bread only being taken, must 
precede the treatment. 

Aspidium. — Male fern. The rhizoma of Aspidium filix mas Swartz, 
and of Aspidium marginale Willdenow (Nat. Ord. Filices). (U. S. P.) 
Fougere male, Fr.; Wurmfarnwurzel, Ger. 

Oleo-resina Aspidii. — Oleo-resin of fern. Dose, 3 ss — 3 ij. 

Composition. — A green, fatty oil, volatile oil, resin, tannin, etc. 
The ethereal extract deposits a granular, crystalline substance (iilicic 
acid), on which the medicinal activity of the drug appears to depend. 

Actions and Uses. — The oleo-resin of filix mas is a very efficient 
remedy for tape-worm, especially the unarmed variety ; but, if suitable 
precautions be taken to insure success, it is quite a certain remedy for 
the armed tsenia. The method of Trousseaux and Pidoux is as efficient 
as any (vol. ii, page 1040). On the first day, a strictly milk diet ; on 
the morning of the second day, four grammes (about 3 j) of the oleo- 
resin in four doses, with an interval of a quarter of an hour between 
each ; on the third day, the same quantity at the same intervals, fol- 
lowed by fifty grammes of the sirup of ether, and, a half -hour later, an 
emulsion containing three drops of croton-oil. Kuchenmeister gives 
a number of methods, and Cobbold favors the employment of male 
fern in certain cases. 

Granatum. — Pomegranate. The bark of the root of JPunica gra- 
natum Linne (Nat. Ord. Granitacece). (U. S. P.) £corce de racine 
de grenadier, Fr. ; Granatwurzelrinde, Ger. 

Composition. — Pomegranate-bark contains a principle — pelleterine 
— on which its activity depends. The tannate, an efficient tseniafuge, 
can be given in doses of five grains to one scruple. 

Actions and Uses. — The rind of the fresh root only should be used. 



ANTHELMINTICS. 659 

The best preparation is the decoction, prepared by boiling gently two 
ounces of the bark in a quart of water down to a pint. Of this decoc- 
tion a wineglassful may be given every hour until all is taken. It 
should be preceded by a brisk purgative, and should be taken fasting. 
It produces more or less nausea, borborygmi, intestinal pain, and usu- 
ally purges. If a purgative effect is not caused by it, a brisk cathartic 
should follow. In the author's experience, this is a very certain and 
efficient tseniafuge. Tauret's preparation of uupurified pelleterine, in 
solution, has acted very efficiently in some cases. 

Brayera. — Kousso. The female inflorescence of Brayera anthel- 
mintica Kunth (Nat. Ord. Rosacea). (U. S. P.) Br ay ere anthelmin- 
thique, Fr. ; Kussobltithen, Ger. 

Mctractum Brayerce Fluidum. — Fluid extract of brayera. Dose, 

3 ij— I j- 

Infusum Brayerce. — Infusion of brayera (six parts to one hundred 
of water). Dose, § iv — § viij — Oj, or more. 

Composition. — Brayera contains an active principle (kosin, or 
koussin), which crystallizes in rhombic prisms. Kosin appears to be 
inert of itself, and is active only when combined with the other con- 
stituents of the drug. 

Actions and Uses. — Kousso is used solely as an anthelmintic. 
Opinions vary as to its utility. On the whole, it may be said that the 
first enthusiasm which attended its introduction into practice has died 
away. It brings the segments, but rarely expels the head of the para- 
site. It is necessary to take it in large quantity — half an ounce — 
mixed with water. It is retained with difficulty, and produces much 
intestinal distress. When successful, the worm is brought away with- 
out the action of a purgative. 

Kamala. — Kamala. The glands and hairs from the capsules of 
Mallotus Philippinensis Mueller Arg. (Nat. Ord. Euphorbiaceoi). 
(U.S. P.) Dose, 3j— 3iij. 

There are no official preparations. A saturated tincture may be 
given, in the dose of one to three drachms. 

Actions and Uses. — It is an orange powder. It causes some nausea 
and griping, usually, but it may operate without producing any un- 
pleasant sensations. It acts as a purgative, and causes the expulsion 
of the worm. If one dose is insufficient, its administration should be 
continued every three hours until five or six doses have been taken. 
Kamala is effective not only against tape-worm, but also against lum- 
brici and ascarides vermiculares. 

Pepo. — Pumpkin-seed. The seed of Cucurbito pepo Linne (Nat. 
Ord. Cucurbitacem). (U. S. P.) 

Actions and Uses. — This is one of the most efficient remedies which 



660 EVACUANTS. 

we possess against taenia. Two ounces of the fresh seed are pounded 
in a mortar, with a half -pint of water, until the husks are loosened and 
an emulsion is made. The mixture is then strained, and the whole 
amount is taken fasting ; but Squibb maintains that all should be taken, 
husks included. If an action of the bowels does not take place in two 
hours, the emulsion should be followed by castor-oil. If success is not 
attained, the dose may be repeated each morning until the parasite is 
produced. Numerous cases of successful use of pumpkin-seed emul- 
sion have been reported. 

The expressed oil, which is bland and unirritating, like almond-oil, 
may be used as a substitute for the seeds. It should be given in the 
dose of a half -ounce, two or more times, and after several hours fol- 
lowed by castor-oil. The rules already given, in regard to preliminary 
treatment, should also be followed. 

Authorities referred to : 

Cobbold, T. Spencer. On Parasites. Also various articles in The Medical Times and 
Gazette, 18*75. 

Husemann, Dr. Theodor. Handbuch, op. cit., erster Band, p. 202. 

Kohler, Dr. Hermann. Handbuch der physiologische TJierapeutiTc, zweiter Band, 
p. 1292. 

Kuchenmeister, Dr. Frederick. On Animal and Vegetable Parasites, Sydenham So- 
ciety, vol. i, p. 147, et seq. 

Stille, Dr. Alfred. Therapeutics and Materia Medica, vol. ii. 

Squibb, Dr. Edward. The Ephemeris, 1883. 



TJR1NO-GENITAL REMEDIES. 

These remedies are employed chiefly for their action on the genito- 
urinary passages. They stimulate the kidneys to increased activity, 
and excite the functions of the pelvic viscera. In excessive quantity, 
or long continued, they may set up inflammation of the kidney, pro- 
duce strangury and bloody urine, excite uterine contractions, and stimu- 
late to an unnatural degree the sexual propensities. They contain an 
essential oil, or principle, which makes its exit by the urinary passages 
and excites local irritation by direct contact. 

Terebinthina. — Turpentine. A concrete oleo-resin obtained from 
Pinus australis Michaux, and from other species of Pinus (Nat. Ord. 
Coniferce). (U. S. P.) 

Oleum TerebinthinaB. — Oil of turpentine. A volatile oil distilled 
from turpentine. (U. S. P.) Essence de ter'ebinthine, Fr.; Terpentinol, 
Ger. Dose, it], v — 1 ss. 

Linimentum Terebinthince. — Liniment of turpentine. (Resin ce- 
rate, sixty-five parts ; oil of turpentine, thirty -five parts.) 



UMNO-GENITALS. 661 

Antagonists and Incompatibles. — All remedies increasing waste, 
and the vasomotor depressants, counterbalance the therapeutical ac- 
tions of turpentine. In cases of poisoning the stomach should be 
promptly emptied, and anodynes and demulcents should be adminis- 
tered. Elimination should be favored, and the toxic symptoms treated 
according to the systemic indications. Ozonized oil of turpentine is 
an antidote to phosphorus, preventing the formation of phosphoric acid 
and converting the poison into an insoluble spermaceti-like substance. 
Turpentine worn in a vial about the neck prevents necrosis of the jaw 
and steatosis of organs in workmen engaged in manufactures employ- 
ing phosphorus. 

Synergists. — The diffusible and alcoholic stimulants favor the 
action of turpentine. 

Physiological Actions. — Turpentine-oil is a limpid, colorless fluid, 
having a strong, peculiar, and diffusive odor, and a hot and pungent 
taste. It is very slightly soluble in water. The oil exposed to the 
air absorbs oxygen (ozone), which it retains with great tenacity. Ap- 
plied to the skin, turpentine causes heat, redness followed by a vesicu- 
lar eruption, and sometimes by intractable ulcerations. A few drops 
produce a sense of heat at the epigastrium, and a large dose (medi- 
cinal) causes intense burning pain, nausea, eructations of the oil, in- 
testinal irritation and purging (usually). Notwithstanding its slight 
solubility in water, turpentine diffuses into the blood with facility, and 
is quickly recognized in the breath, sweat, and urine. The action of 
the heart and arteries is increased by it, the arterial tension rises, and 
a general sense of warmth and exhilaration is experienced. In large 
doses (one or two ounces) vomiting, thirst, and a febrile state, are 
induced ; the muscular strength is diminished, the power of co-ordina- 
tion is impaired ; exhilaration of mind, incoherence of ideas, and ram- 
bling insensibility, follow. In toxic doses there are complete muscular 
relaxation and profound insensibility with abolition of all reflex move- 
ments ; the face is flushed or cyanosed, the pupils usually dilated, and 
the breathing labored and stertorous. All the organs by which tur- 
pentine is eliminated, especially the kidneys, suffer from extreme irri- 
tation when large doses have been swallowed. The skin is usually 
moist, and exhales a turpentine-odor ; the bronchial secretion is in- 
creased, and convulsive coughing is induced ; the urine is scanty and 
bloody, and there is violent strangury. The only fatal cases which 
have been reported have occurred in children (Taylor). From four 
to six ounces have not destroyed life in adults. 

As regards its action on the organs of circulation, the author's 
experiments show that turpentine stimulates the vaso-motor nervous 
system when administered in moderate doses. A large quantity 
quickly exhausts the irritability of the sympathetic ganglia, the action 
of the heart becomes weak, and the arterial tension falls ; the respira- 



662 EVACUANTS. 

tory movements are at first stimulated, but afterward become shallow, 
and carbonic-acid poisoning supervenes. The brains of animals killed 
by turpentine smell strongly of it, and hence it may be concluded that 
it has a direct action on the cells of the cerebral lobes. 

Turpentine has decided antiseptic power. It arrests fermentation 
processes, putrefaction, and is very destructive of minute organisms 
(vibrio, bacteria, etc.). 

The vapor of turpentine inhaled produces nasal and bronchial irri- 
tation, frontal headache, and renal irritation, even bloody urine and 
strangury. 

On post mortem after turpentine-poisoning, violent gastro-intestinal 
irritation, ecchymoses of the air-passages, congestion of the lungs, and 
hyperemia of the kidneys, are noted. 

Therapy. — Flatulence may be quickly relieved by a few drops 
(three to five) of turpentine, on a lump of sugar. This remedy is 
especially indicated in flatulence persisting from a paretic state of the 
muscular layer of the bowel. There is abundant evidence to prove the 
curative power of oil of turpentine in chronic intestinal catarrh. It is 
especially indicated when the tongue is dry and glazed, when there is 
tympanitic distention of the bowels, and w T hen the alvine discharges 
consist either of fluid faeces or scybala, mixed with mucus and pale, 
watery blood. It is best administered in an emulsion, with almond- 
oil and opium. ^ 01. terebinthini, 3 j ; ol. amygdal. express., § ss ; 
tinct. opii, 3 i j ; mucil. acacise, 3v; aquae laur.-cerasi, 3 ss. M. Sig. : 
A teaspoonful every three, four, or six hours. The same remedy, in a 
similar combination, is very effective in acute dysentery after the sub- 
sidence of the more acute symptoms. The following is probably the 
true explanation of its action in these cases : it gives tonicity to the 
vessels, and to the muscular fiber of the intestines ; arrests the putre- 
factive and fermentative processes which take place in the vitiated 
mucus and articles of food, and increases the cutaneous capillary circu- 
lation, thus relieving congestion of internal organs. 

Stimulating enemata are made of turpentine, mucilage, oils, etc. 
These are especially indicated in constipation, and in impaction of 
the rectum. I£ 01. terebinthini, 3 ij — 3 j ; ol. ricini, | ij ; vitell. ovi 
unius ; decoct, hordei, § viij — Oj. M. Sig.: As an enema. Such in- 
jections are frequently used in tympanitic distention of the large 
intestine, in flatulent colic, in impaction of the caecum, etc. 

A combination of equal parts of turpentine and ether constitutes 
the well-known remedy of Durand for the solution and cure of biliary 
calculi. Notwithstanding the unquestionable utility of this remedy, 
we can not admit with Durand that its efficacy depends on its solvent 
power (Trousseau). During the attack of biliary colic this remedy 
may be administered with a view to its anodyne and antispasmodic 
effect ; but, as Kohler states, it is by no means equal to morphine and 



UMNO-GENITALS. 663 

chloral hydrate. In the after-treatment, clinical experience is in favor 
of the occasional administration of Durand's remedy during a course 
of Vichy or Carlsbad water. 

Turpentine is one of the most effective remedies which we possess 
in the treatment of taeniae. Full doses ( § ss — § ij) are required, and 
the rules for preliminary treatment already laid down (see Anthel- 
mintics) should be adhered to. Turpentine should be combined with 
a purgative, in order to insure prompt cathartic effect. If absorption 
of any considerable part of the turpentine takes place, violent intoxica- 
tion will follow, and irritation of the kidneys, haematuria, and stran- 
gury, will be produced in the efforts at elimination. The oleo-resin 
of filix mas may be combined with turpentine. I> 01. terebinthinae, 
5 j ; oleo-resinae filicis, 3 j ; vitell. ovi no. ij ; ol. ricini, f j. M. Sig. : 
A draught. This is an effective, but by no means an agreeable, mix- 
ture. An ounce each of turpentine and castor-oil may be administered, 
as the cathartic, after the use of the decoction of pomegranate. 

Turpentine being a cardiac stimulant, and an excitant of the capil- 
lary circulation, is contraindicated in hypertrophy of the heart, and 
when advanced atheroma of the cerebral arteries may be presumed to 
exist. It is a serviceable cardiac stimulant when the action of the 
heart is weak, and the arterial tension low. In the passive haemor- 
rhages we possess few agents more generally useful. The indications 
for its use are a condition of debility, relaxation of the vessels, and an 
impoverished condition of the blood. Transudations on the free mu- 
cous surfaces — epistaxis, bronchial haemorrhage, haematemesis, intesti- 
nal haemorrhages, haematuria— when associated with the state of con- 
stitutional depression defined above, are forms of haemorrhage in which 
turpentine should be used. ^ 01. terebinthinse, 3 iij ; ext. digitalis 
fl., 3 j ; mucil. acaciae, 1 ss ; aquae menthae pip., f j. M. Sig. : A 
teaspoonful every three hours. The hsemorrhagic transudations which 
take place in purpura, in scorbutus, and allied states, are also arrested 
by turpentine. It need hardly be stated that active haemorrhage and 
a condition of plethora contraindicate the use of turpentine. 

As a stimulant to the vaso-motor nervous system, turpentine is in- 
dicated in fevers when the action of the heart is feeble, the arterial 
tension low, and the peripheral circulation languid. Ten drops in an 
emulsion is a suitable form, and every two hours is a proper interval 
for its administration in this condition of things. According to G. B. 
Wood, a dry tongue, peeling off in flakes, leaving a glazed surface be- 
neath, is a special indication for the use of turpentine in fevers. The 
intestinal haemorrhage of typhoid may be restrained by turpentine. 

Clinical experience is in favor of the use of turpentine in puerperal 
fever and in yellow fever. The indications for its employment in 
these maladies are just the same as those mentioned above in typhoid. 
Cardiac weakness, depression of the vaso-motor nervous system, a dis- 



664 EVACUANTS. 

solved state of the blood, are the conditions requiring turpentine. 
Tympanitic distention of the abdomen is an additional indication in 
puerperal fever. Similarly, turpentine is used in epidemic dysentery, 
traumatic erysipelas, hospital gangrene, etc. In these various states, 
employed with a well-defined conception of its real powers, this remedy 
is more generally serviceable as a stimulant than alcohol. As respects 
the dosage, in febrile diseases, a rule may be formulated as follows : 
for the intestinal complications, small doses frequently repeated (ten 
drops) ; as a stimulant to the vaso-motor nervous system, larger doses 
(tti x — 3 ss) at somewhat longer intervals. 

In the article on " Phosphorus " attention has been called to the 
utility of turpentine in poisoning by this substance. 

The physiological effects of turpentine indicate its utility in certain 
disorders of the nervous system. As an enema, turpentine has been 
used for its derivative effect in insolation or sunstroke (Levick, Wood), 
and in cerebrospinal meningitis (Hirsch). So accurate an authority 
as Topinard maintains the utility of this remedy in the cystic compli- 
cations of posterior spinal sclerosis. Turpentine has long been used 
successfully in epilepsy, but in those cases only in which the seizures 
were due to the reflex impression of intestinal parasites (taeniae). Tic- 
doidoureux and sciatica, when rheumatic in origin, or when produced 
by fecal accumulations, have been cured by the vigorous use of turpen- 
tine, but we have now other means of treatment more generally useful 
and less disagreeable. 

As turpentine is largely eliminated by the bronchial and renal mu- 
cous membrane, decided effects are produced at these points. In dif- 
fusing outward, a change in the tonicity of the vessels, and in the 
character of the secretions, must necessarily be produced. Clinical 
experience confirms the deductions of theory. In chronic bronchitis, 
with profuse expectoration (bronchorrhcea), especially when the expec- 
torated matters have a fetid odor, turpentine is an excellent remedy 
(Oppolzer). In gangrene of the lung, although it is not curative, it 
acts beneficially in diminishing the fetor. In pneumonia and capil- 
lary bronchitis, when the vital powers are depressed and the peripheral 
circulation is feeble, turpentine is one of the best stimulants which we 
can employ. The depression which occurs during the period of crisis 
in pneumonia, and the condition of purulent infiltration, especially in- 
dicate the use of this remedy. In the so-called humid asthma, and in 
emphysema with profuse bronchial catarrh, good results are obtained 
by the use of turpentine. In these various pulmonary maladies, the ac- 
tion of turpentine is largely local, as already explained, but it should not 
be forgotten that the powerful stimulation of the cutaneous circulation 
which it causes must contribute no small share of the curative action. 
In hydro-nephrosis and pyo-nephrosis turpentine is used as in bron- 
chial catarrh, viz., to alter by actual contact the relaxed condition of 



URINO-GENITALS. 665 

the vessels, and the pathological secretions of the mucous membrane. 
It is, of course, contraindicated during the existence of acute symptoms. 
Chronic catarrh of the bladder is not unfrequently much improved by 
the use of this agent. It is most serviceable in those cases resulting 
from a transference of urethral inflammation, or due to prostatic dis- 
ease. Incontinence of urine, the result of atony of the muscular layer 
of the bladder, is sometimes removed by small doses of turpentine. 
Chronic gonorrhoea, gleet, spermatorrhoea, and prostorrhoea, when the 
discharges peculiar to these maladies are due to a relaxed condition of 
the affected parts, are not unfrequently remarkably benefited by mod- 
erate doses of turpentine. 

External Uses of Turpentine. — The author long ago pointed 
out the fact that turpentine is one of the most efficient applications in 
hospital gangrene. The mortified parts are first removed with the 
scissors, and the remedy is then applied directly to the affected sur- 
face, by means of a piece of cotton cloth saturated with it. Fetor is 
removed and sloughing is arrested, and but little pain attends the 
application. 

Turpentine-stupes are much employed as a local and external means 
of treating internal inflammations. A piece of spongio-piline, or of 
flannel, large enough to cover the affected part, is first moistened with 
hot water, and then a few drops of turpentine (five to ten drops only) 
are sprinkled on it. As very severe smarting, inflammation, and vesi- 
cation of the skin may occur from the application, and be experienced, 
indeed, some time subsequently to the removal of the stupe, care must 
be used not to continue it too long. 

Liniment of turpentine is a convenient counter-irritant in cases of 
myalgia, superficial neuralgia, lumbago, etc. An excellent counter- 
irritant application is made by mixing equal parts of oil of turpentine, 
acetic acid, and liniment of camphor (Stille). The most successful 
treatment of severe burns is by the plan of Kentish, which consists in 
first washing the injured surface with turpentine, and then applying an 
ointment made by mixing basilicon-ointment with turpentine. Ery- 
sipelas has been treated by the same measures by Meigs, and the same 
applications are generally in use in chilblains. 

Inhalations of turpentine-vapor, or atomized turpentine, is an effi- 
cient means of local treatment in chronic laryngeal and bronchial af- 
fections. As a matter of curious therapeutics, it may be mentioned 
that gonorrhoea has been successfully treated by requiring the patient 
to inhale the vapor of turpentine. 

Authorities referred to : 

Bartholow, Dr. Roberts. The Cincinnati Lancet and Observer, October, 1864. 
Da Costa, Dr. J. M. The American Journal of the Medical Sciences, January, 1866. 
Levick, Dr. R. J. TJie American Journal of the Medical Sciences, January, 1869. 
Little, Dr. The Practitioner, vol. Lx, p. 369. 



666 EVACUANTS. 

Oppolzer, Prof. Allgem. Wiener med. Zeit, No. xxxiii, 1866. 

Stille, Dr. A. Therapeutics and Materia Medica, vol. ii, p. 753. 

Topinard, Dr. L. De VAtazie Locomotrice, etc., Paris, 1864. 

Trousseau, Dr. A. Clinique Medicate de V Hotel Dim. 

Trousseau et Pidoux. Traite de Therapeutique et Matiere Medicate, vol. ii, p. 802. 

Wood, Dr. George B. The Practice of Medicine, fourth edition, vol. i, p. 346. 

Wood, Dr. H. C. American Journal of the Medical Sciences, October, 1863. 

Copaiba. — Copaiba. The oleo-resin of Copaifera Langsdorfii Des- 
fontaines, and of other species of Copaifera (Nat. Ord. Leguminosce, 
Papilionacew). (U. S. P.) Baume de copahu, Fr.; Copaiv a- Balsam, 
Ger. Dose, tt[ x — 3 j. 

Massa Copaibce. — Mass of copaiba. (Copaiba, 94 parts ; magne- 
sia, 6 parts.) 

Oleum Copaibas. — Oil of copaiba. A volatile oil distilled from 
copaiba. Dose, ttx, v — 3 ss. 

Besina Copaibaz. — Resin of copaiba. The residue left after dis- 
tilling off the volatile oil from copaiba. Dose, gr. j — gr. v. 

Composition. — Balsam of copaiba differs from the true balsams in 
not containing cinnamic acid. It is an oleo-resin, the volatile oil con- 
stituting from forty to sixty per cent. The oil of copaiba is isomeric 
with the oil of turpentine, but it differs in some of its physical prop- 
erties from the latter. The resin has an acid reaction, and has been 
entitled copaivic acid. 

Actions and Uses. — Copaiba has a nauseous, bitter, and very dis- 
agreeable taste. When taken into the stomach it causes some heat, 
and offensive eructations, tasting of the balsam, occur. Indigestion, 
heaviness at the epigastrium, anorexia, are frequently produced by it, 
and diarrhoea is an occasional result of its use. It is, therefore, a gas- 
trointestinal irritant. Both the oil and the resin diffuse into the blood. 
The various excretions, the sweat, the bronchial mucus, the urine, ac- 
quire a peculiar and rather a fragrant odor from its presence. This 
odor is especially observable in the urine, and in this secretion the resin 
may be discovered also by the addition of nitric acid, which causes a 
precipitate. At the points of elimination more or less irritation is pro- 
duced, and, as a result of the irritation, increased secretion ; hence co- 
2^aiba is said to be diaphoretic, diuretic, and expectorant. Very serious 
injury may be done to the gastro-intestinal canal, and to the kidneys, 
by the use of this agent in large doses. The author has known gastro- 
intestinal catarrh to persist many months after a course of copaiba, and 
he has reason to believe that desquamative nephritis and fibroid kid- 
ney have resulted from its free administration for a lengthened period. 
While small doses of balsam will increase the gross amount of urine 
and of the solid contents, large doses will actually cause a diminution 
in the amount both of water and solids by setting up renal irritation. 
Although, during a course of balsam, nitric acid causes a precipitation 



URINO-GEXITALS. 667 

of the resin, which is dissolved on the addition of alcohol, the author 
has, in several instances at least, detected albumen in the urine of those 
taking this remedy. 

Copaiba is contraindicated when a condition of gastro-intestinal ir- 
ritation and hyperemia of the kidneys exist. 

Gonorrhoea is the disease to which copaiba is most especially 
adapted. Its administration should not be begun, however, until after 
the acuter symptoms have subsided. As the action of the remedy is 
local or direct, acute symptoms are rather aggravated by it. Combina- 
tion with liquor potassae promotes its curative action by diminishing 
the acidity, and hence the irritation produced by the urine. Combina- 
tion with agents acting synergistically, as oils of cubebs and sandal- 
wood, is also desirable- The following formulae exemplify these thera- 
peutical facts : ^ Copaibae, pulv. cubebae, aa J ij ; aluminis, § j ; opii, 
gr. v. M. Sig. : One to two drachms, night and morning. ^ 01. 
copaibae, ol. cubebae, ol. santal. flav., aa 3 j ; magnesiae, 3 ij. M. Ft. 
pil. no. lx. Sig. : Two pills every four hours. 

In chronic catarrh of the bladder, copaiba is useful by virtue of the 
local action which it has upon the mucous membrane. Its nauseous 
taste and the gastric and renal irritation produced by it are serious 
objections to its use in a malady which requires the persistent and 
long-continued application of remedies in order to even moderate its 
symptoms. 

For acute bronchitis after the subsidence of the fever, for chronic 
bronchitis with profuse secretion, for bronchorrhoea (dilated bronchi), 
copaiba is the most generally serviceable expectorant. Unfortunately, 
it is so disagreeable that it is difficult to overcome the repugnance of 
patients. Even when administered in capsules, or in pill-form with 
magnesia, the nauseous eructations excite disgust. ^ Copaibae, bal- 
sam, tolutan., pulv. acaciae, aa I ss ; acid, sulphur, aromat., 3 ss ; aquae 
destil., I vj. M. Sig. : A tablespoonful, two or three times a day, in 
chronic bronchial affections, whooping-cough, etc. $ Copaibae ; syrp. 
tolutan., aa \ ss ; aquae menthae pip., § ij ; spirit, etheris nitrosi, I j. 
M. Sig. : A teaspoonful every four hours. 

Excellent results have been obtained from the use of copaiba in 
dropsy, especially in ascites. In these cases it acts powerfully on the 
kidneys. Wilks holds that copaiba-resin is a more efficient diuretic 
than the balsam. ^ Res. copaibae, 3 iij ; alcohol., 3 v ; spirit, chloro- 
formi, 3 j ; mucil. acaciae, I ij ; aquae ad 3 xij. M. Sig. : A table- 
spoonful ter in die. It is conveniently given in pill-form also. 

In some subjects possessed of an irritable skin, copaiba produces an 
eruption of urticaria, or roseola, or erythema. This is not in conse- 
quence of a selective action on the skin, but is the result merely of the 
gastro-intestinal disturbance. Influenced, probably, by this fact that 
an eruption may be caused by copaiba, this agent has been proposed 



668 EVACUANTS. 

as a remedy in certain cutaneous diseases — in those characterized by 
torpor of the peripheral circulation. 

Authorities referred to : 

Bernatzik, Prof. Dr. W. Prag. Vjhrschr., c, p. 239. Schmidt's Jahrbucher, vol. 
cxli, p. 278. 

Fluckiger and Hanbcry. Pharmacographia, p. 200, et seq. 

Gubler, Dr. A. Commentaires Therapeutiques, p. 86, et seq. 

Husemann, Dr. Theodor. Handbuch, p. 1195, et seq. 

Kohler, Dr. Hermann. Handbuch, erste Halfte, p. 370, et seq. 

Trousseau et Pidoux. Traite de Therap. et de Mat. Med., vol. ii. 

Weikart, Dr. H. Archiv der Heilk., i, ii, p. 176, 1860. Schmidt's Jahrbiicher, vol. 
cvi, p. 162. 

Wilks, Dr. S. The Lancet, 1873, vol. i, p. 410. 

Cubeba. — Cubeb. The unripe fruit of Cubeba officinalis Miquel 
(Nat. Ord. Piperacece). (IT. S. P.) Cubebes, Fr. ; Cubeben, Ger. 

JExtractum Cubeboe Fluidum. — Fluid extract of cubeb. Dose, 3 ss 
— 3ij- 

Oleum Cubebrn. — Oil of cubeb. Dose, tt[ v — 3 ss. 

Oleo-resina Cubebai. — Oleo-resin of cubeb. Dose, ti^ v — 3 ss. 

Tinctura Cubeboe. — Tincture of cubeb. Dose, 3 ss — 3 ij. 

Trochisci Cubebm. — Troches of cubeb. 

Composition. — Cubeb contains a volatile oil which varies in pro- 
portion from six to fifteen per cent. It is polymeric with oil of turpen- 
tine. This volatile oil separates in the cold into two distinct substances 
— a camphoraceous substance (cubebene), and a liquid portion {cubeben). 
Besides these, a neutral crystallizable principle (cubebin) has been iso- 
lated. Cubeb also contains a resin, divisible into two distinct sub- 
stances, an indifferent portion and an acid {cubebic acid). The thera- 
peutical properties of the drug reside chiefly, if not exclusively, in the 
oil and resin, hence the oleo-resin is an efficient preparation. 

Actions and Uses. — The taste of cubeb is aromatic, pungent, and 
somewhat camphoraceous. In the stomach it excites a sensation of 
warmth, and, in moderate doses, promotes the appetite and the diges- 
tive capacity. In considerable doses it is laxative, and produces a feel- 
ing of heat and irritation about the rectum. Ingested in a large quan- 
tity, cubeb sets up a gastro-intestinal catarrh, and may even cause acute 
inflammatory symptoms. The active principles diffuse into the blood. 
The action of the heart and vascular system is increased by cubeb, the 
surface becomes warm and perspiring under its use, and the bronchial 
and urinary secretions are more abundant. The odor of cubeb is im- 
parted to the breath and to the* urine, and the resin may be precipi- 
tated from the urine by the addition of nitric acid. As explained in 
the previous article (Copaiba), the resin precipitated by nitric acid re- 
sembles albumen, but differs from the latter substance in being soluble 
in alcohol. 



URINO-GENITALS. 669 

Cubeb stimulates the venereal appetite in man, and promotes the 
catamenial flux in women. 

Finely-powdered cubeb is an efficient local application in chronic 
nasal catarrh. It is blown into the nares by an insufflator. It gives 
considerable relief also in hay-asthma, when there is no fever, and the 
secretion of the nasal mucous membrane is profuse and watery. Pow- 
dered cubeb is useful as a topical application when the mucous mem- 
brane of the fauces is relaxed, or the seat of chronic inflammation {fol- 
licular pharyngitis). The official cubeb-troches are employed by sing- 
ers and public readers, to maintain the tonicity of the mucous mem- 
brane and to prevent or relieve hoarseness. 

Cubeb may also be used, in small doses, to promote secretion and 
increase digestion in cases of atonic dyspepsia. Chronic catarrh of the 
colon and rectum, with a relaxed condition of the mucous membrane 
and of the inferior hemorrhoidal vessels, may be removed by cubeb. 
Sometimes these cases take the form of a mucous dysentery. 

The most important application of cubeb is in the treatment of 
gonorrhoea. Unlike copaiba, it may be administered with good effect 
during the acute stage. The best results are obtained from a mixture 
of the two agents. Catarrh of the bladder, prostorrhcea, spermator- 
rhoea, are maladies in which cubeb may be employed with more or less 
advantage. When the sexual appetite is weak, and the erections fee- 
ble, cubeb will sometimes, if the troubles are functional, remove them. 

Irritability of the bladder, nervous or functional in character, espe- 
cially as it occurs in women, is generally relieved by cubeb ; but can- 
tharides is a more efficient remedy for this troublesome affection. 

In chronic bronchial affections, with profuse expectoration, cubeb 
has a remedial effect similar to that possessed by copaiba, and is useful 
under the same conditions. 

Piper. — Black pepper. The unripe berries of Piper nigrum Linne 
(Nat. Ord. Piperacem). (IT. S. P.) Poivre noir, Fr. ; Schwarzer 
Pfeffer, Ger. 

Composition. — Pepper contains a resin and an essential oil, and a 
neutral crystallizable principle (piperbi). 

Oleo-resina Piperis. — Oleo-resin of black pepper. This contains the 
active constituents of pepper, and is an eligible preparation. Dose, 

m j— m v. 

Piperina. — Piperin. A proximate principle of feebly alkaloidal 
power, prepared from pepper, and occurring also in other plants of the 
natural order Piperaceai. Colorless, or pale yellowish shining, four- 
sided prisms, permanent in the air, odorless and almost tasteless when 
first put in the mouth, but on prolonged contact producing a biting 
sensation. It has a neutral reaction, is almost insoluble in water, but 
soluble in thirty parts of alcohol at 60° Fahr. Dose, gr. j — gr. x. 



670 EVACUANTS. 

Capsicum. — Capsicum. The fruit of Capsicum fastig latum Blurae 
(Nat. Ord. Solanacece). (U. S. P.) Poivre tflnde, Fr. ; Spanischer 
Pfeffer, Ger. 

Composition.-— The acrid, pungent qualities of capsicum are due to 
a peculiar substance (capsicin), a thick, yellowish-red liquid. Felle- 
tar, whose observations have been confirmed by Fltickiger, has isolated 
a volatile alkaloid having the odor of conine. 

Mctractum Capsici Fluidum. — Fluid extract of capsicum. Dose, 
hi v— 3 j. 

Oleo-resina Capsici. — Oleo-resin of capsicum. Dose, ttx j — ti], v. 

Tinctura Capsici. — Tincture of capsicum. Dose, Tit x — 3 j. 

Actions and Uses. — Notwithstanding black and red pepper belong 
to different orders, they are closely related therapeutically and in their 
physiological actions. They may with propriety be considered together. 

When applied to the skin, pepper excites redness, heat, and super- 
ficial inflammation. Red pepper, if in contact with the skin a suffi- 
cient length of time, will produce vesication. It also causes great irri- 
tation of the mucous membrane. It has a hot, pungent, and rather 
acrid taste, and increases the flow of saliva. In the stomach a sensa- 
tion of warmth is produced by it, the secretions are more abundant, 
digestion is more active, and the appetite is promoted. In an exces- 
sive quantity gastritis may be produced. The intestinal secretions are 
no doubt increased, and the alvine evacuations rendered more easy and 
copious. 

The action of the heart and arteries is increased by pepper, a sub- 
jective sensation of warmth is experienced throughout the system, and 
cutaneous transpiration becomes more abundant. Elimination takes 
place chiefly through the kidneys. The flow of urine is increased, 
micturition is more frequent, and more or less vesical tenesmus occurs. 
Decided aphrodisiac effects are produced by red pepper. 

The tincture of capsicum may be usefully employed as a stomachic 
in atonic dyspepsia. It is especially indicated in the dyspepsia of 
chronic alcoholism, when there are present trembling and insomnia. 
Flatulent colic may be relieved by capsicum, especially when this dis- 
order occurs in hysterical subjects. The author has seen excellent re- 
sults from the use of this remedy in the dyspepsia and flatulence of 
hypochondriacal subjects, and of women at the climacteric period. 

Capsicum is an excellent addition to beef -tea when this aliment is 
administered in fevers, and other low conditions of the system. The 
tincture may be employed under the same circumstances as a cardiac 
stimulant. Piperin has been used in cholera as a stimulant, local and 
general, and in low conditions of the system from any cause except 
gastro-intestinal inflammation. At one time it was much prescribed 
in malarial fevers as an adjunct to quinine chiefly, and antiperiodic 
powers were ascribed to it ; but such views are no longer entertained. 



URINO-GENITALS. 671 

The evidence is conclusive that capsicum quiets restlessness and 
induces sleep in delirium tremens. It may be administered mixed with 
beef -tea or other animal broths, or thirty grains made into a bolus, 
with sirup or honey, may be given. As capsicum belongs to the fam- 
ily Solanacem, and as Felletar discovered in it a volatile alkaloid, a ra- 
tional explanation is afforded of its action on the cerebrum. Accord- 
ing to Ringer, the tincture of capsicum is the best substitute for the 
stimulant when an attempt is made to break the alcohol-habit. It 
is also very serviceable in the treatment of the opium-habit. The good 
effect of the remedy in these cases is in part due to its action as a 
stomachic stimulant, and partly, doubtless, to its cerebral effects. 

The oleo-resins of black and red pepper have been used with good 
results in the treatment of intermittent fever. They are useful chiefly 
as adjuvants to more efficient remedies. 

Capsicum is contraindicated in all acute affections of the genito- 
urinary apparatus. In chronic parenchymatous nephritis it checks the 
waste of albumen. In chronic pyelitis, chronic cystitis, and prostor- 
rhoea, it has a beneficial effect ; but, although similar in action to, it 
is less efficient than, cubeb. Excellent results are often obtained from 
it in functional impotence, and in spermatorrhoea from deficient tone. 
In these genito-urinary maladies, the oleo-resin is the best preparation 
for administration. 3 Oleo-resinse capsici, 3] ; ergotin (aq. ext.), 
3 ij. M. Ft. pil. no. xx. Sig. : One three times a day. 

A capsicum-plaster is a mild counter-irritant. The infusion is em- 
ployed as a gargle in tonsillitis, diphtheria, and scarlet fever. As it is 
a very irritating application, its use should be restricted to cases char- 
acterized by a low grade of action. 

Junipems. — Juniper. The fruit of Juniperus communis Linne 
(Nat. Ord. Coniferce). (U. S. P.) Baies de genievre, Fr. ; Wach- 
holderbeeren, Ger. 

Infusum Juniperi. — Infusion of juniper ( | j — Oj). Dose, 3 ss — 
1 ij. (Not official.) 

Oleum Juniperi. — Oil of juniper. Dose, v\ v — -nt xx. 

Spiritus Juniperi Compositus. — Compound spirit of juniper. (Oil 
of juniper, 10 parts ; alcohol, 3,000 parts ; water, sufficient to make 
5,000 parts ; oils of caraway and fennel, each one part.) Dose, \ ss 

Spiritus Juniperi. — Spirit of juniper. (Oil of juniper, 3 parts ; 
alcohol, 97 parts.) Dose, 3 j — 1 j. 

Composition. — Juniper contains a volatile oil, upon which its me- 
dicinal effects chiefly depend. A non-cry stallizable principle (juni- 
perine) exists in the berries in very small quantity. It contains also 
formic, acetic, and malic acids. 

Actions and Uses. — Juniper increases the appetite and digestion, 



672 EVACUANTS. 

but in overdoses will disorder the stomach. The volatile oil diffuses 
into the blood with facility. Increased action of the heart and of the 
arteries, a subjective sensation of warmth, diaphoresis, and diuresis, 
are produced by it. 

The oil is eliminated by the kidneys chiefly, and imparts an odor 
of violets to the urine. It powerfully stimulates the renal functions, 
and in large doses causes strangury and bloody urine. It may set up 
a high degree of irritation of the kidneys, leading to suppression and 
uraemic intoxication. In common with the other remedies of this 
group, juniper excites the venereal appetite; in large doses may cause 
priapism, and in women promotes the menstrual flow. 

The principal use of juniper is as a diuretic. It is contraindicated 
in acute affections of the kidneys. It is largely employed as a diuretic 
in cardiac and renal dropsy. The infusion is an excellent vehicle for 
the exhibition of saline diuretics in these affections. The oil of juniper 
acts similarly to, and is indicated under the same conditions as, tur- 
pentine in chronic pyelitis, chronic cystitis, gleet, prostorrhcea, etc. 
Diuretic effects may be obtained by inhalation of the vapor of the oil. 
For this purpose a few drops may be put into hot water, and the vapor 
be inhaled. 

The empyreumatic oil of juniper (oleum cadinum), obtained by de- 
structive distillation from Juniperus oxycedrus, is a thick, black liquid, 
similar in appearance to and smelling like common tar. It is much 
employed as a local application in chronic eczema, impetigo, ichthyosis, 
psoriasis, acne rosacea, etc. It is usually combined with German soft- 
soap. 3 Alcoholis, saponis mollis, ol. cadini, aa § j ; ol. lavendula?, 
3 jss. M. fy 01. juniperis empy. (ol. cadini), saponis mollis, aa 3 j ; 
ol. lavend., 3 ss. M. Sig. : Ointment. t> 01. juniperis empy., 3 j — 
I j ; sevi, § ss ; adipis, f j. M. Sig. : Ointment. 

Erigeron. — Erigeron. The leaves and tops of Erigeron heterophyl- 
lum, and of Erigeron Philadelphicum. (Pharm. 70.) 

Erigeron Canadense. — Canada erigeron. 

Oleum Erigerontis Canadensis. — Oil of Canada erigeron. Dose, 
Hi v — TTi x. 

Actions and Uses. — Erigeron possesses a diuretic property to a 
slight extent. Canada erigeron is the more active, and contains a 
much larger proportion of volatile oil. The actions and uses of the 
oil are the same as the oil of turpentine, but the latter is the more 
efficient remedy. The oil of Canada erigeron has a local reputation 
in Philadelphia as an haemostatic agent. It is said to be effective 
in menorrhagia, and cases of intestinal haemorrhage arrested by it 
have been reported. It is adapted only to the treatment of passive 
haemorrhages, and is probably less curative than turpentine in these 
cases. 



UMNO-GENITALS. 673 

Buchu. — Buchu. The leaves of Barosma betulina and of other 
species of Barosma (Nat. Ord. Butacece). (IT. S. P.) Feuilles de buceo, 
Fr. ; Bukublatter, Ger. 

Infusum Buchu. — Infusion of buchu ( § j — Oj). Dose, 1 ss — 3 ij. 
(Not official.) 

Fxtractum Buchu Fluidum. — Fluid extract of buchu. Dose, t\[ x 

-3j. 

Composition. — Buchu contains a volatile oil in the proportion of 
about 1*5 per cent. This volatile oil consists of a crude oil and a 
camphor — barosma camphor. The latter has a nearly pure peppermint 
odor. The existence of barosmin, so called, is doubtful. 

Uva Ursi. — Uva ursi. The leaves of Arctostaphylos uva ursi 
Sprengel (Nat. Ord. Ericacece). (U. S. P.) Feuilles de busserole, 
Fr. ; Barentraubenbldtter, Ger. 

Decoctum Uvce Ursi. — Infusion of uva ursi ( 1 j — Oj). Dose, % ss 
— 3 ij. (Not official.) 

Fxtractum Uvce Ursi Fluidum. — Fluid extract of uva ursi. Dose, 
3 ss — 3 ij. 

Composition. — Uva ursi contains a bitter, neutral, crystallizable 
substance, arbutin ; a very bitter amorphous principle, ericolin ; and 
a tasteless, crystallizable, neutral principle, ursone. It is rich in gallic 
and tannic acids. 

Pareira. — Pareira brava. The root of Chondodendron tomentosum 
Ruiz et Pavon (Nat. Ord. Menispermacece). (IT. S. P.) Bacine de 
pareira-brava, Fr. ; Grieswurzel, Ger. 

Infusum Pareirce. — Infusion of pareira brava (^j — Oj). Dose, 
1 ss — 1 ij. (Not official.) 

Fxtractum Pareirce Fluidum. — Fluid extract of pareira. Dose, 
3 ss— I ij. 

Composition. — It contains a principle, buxin, but it is not known 
whether this is the active ingredient. 

Chimaphila. — Pipsissewa. The leaves of Chimaphila umbellata 
Nuttall (Nat. Ord. Ericacece). (U. S. P.) 

Decoctum Chimaphilce. — Decoction of chimaphila. Dose, f ss — 
I ij. (Not official.) 

Fxtractum Chimaphilce Fluidum.- — Fluid extract of chimaphila. 
Dose, 3 ss — 3 ij. 

Composition. — Pipsissewa contains a crystallizable principle, chi- 
maphilin, tannic acid, extractive matters, etc. 

Scoparius. — Broom. The tops of Sarothamnus scoparius Koch 
(Nat. Ord. Leguminosce). (U. S. P.) Genet d balais, Fr.; Pfriemen- 
kraut, Ger. 
43 



674 EVACUANTS. 

There are no preparations official in the United States Pharmaco- 
poeia. A decoction and fluid extract corresponding to those above 
mentioned may be employed. 

Composition. — Scoparius contains an indifferent or somewhat acid 
crystallizable principle, scoparin, and an oily, colorless, liquid alkaloid, 
sparteine. The latter has very decided basic qualities, and agrees 
with conine and nicotine in being constituted without oxygen. 

Actions and Uses.— Buchu, uva ursi, pareira, pipsissewa, and sco- 
parius, form a group of diuretics with properties in common. They 
are tonic, astringent diuretics. They promote appetite and digestion, 
and restrain intestinal movements, except pareira, which has rather a 
laxative action. Their active constituents diffuse into the blood and 
are eliminated by the kidneys. In passing over the genitc-urinary 
tract these principles act topically upon the mucous membrane. As a 
rule they are actively diuretic ; that is, they increase the amount of 
urinary water. Pipsissewa and scoparius are rather more actively diu- 
retic than buchu and uva ursi, and hence are more useful in dropsy. 
By English physicians generally, and notably the late Dr. Pereira, sco- 
parius is held in much esteem as a remedy for dropsy. It is adapted 
especially to the treatment of cardiac dropsy, and the general anasarca 
of chronic parenchymatous nephritis, but is inadmissible in acute af- 
fections of the kidney. Our indigenous remedy, pipsissewa, may be 
substituted for scoparius in the treatment of dropsy. 

Buchu, uva ursi, and pareira, are more particularly useful in chronic 
pyelitis, catarrh of the bladder, chronic gonorrhoea, etc. ; and of these 
the most efficient, probably, is buchu. The fluid extract is the most 
eligible form in which these remedies can be administered. 

Carota. — Carrot-seed. The fruit of Daucus carota. The wild car- 
rot. (Pharm. 70.) 

The seeds of carrot have a hot, pungent, and bitter taste, due to a 
volatile oil which they contain, and to which their medicinal activity is 
due. As they impart their virtues to water, an infusion of the seeds 
is an eligible form in which to administer the remedy. Carrot-seeds 
act similarly to juniper, and produce diuresis, augment the menstrual 
flux, and cause aphrodisiac effects in the male. 

Taraxacum. — Dandelion. The root, gathered in the autumn, of Ta- 
raxacum dens-leonis Desfontaines (Nat. Ord. Compositce). (U. S. P.) 
Pissenlit, Fr. ; Ldwenzahnwurzel, Ger. 

Extr actum Taraxaci. — Extract of taraxacum. Dose, gr. v — 3 j. 

Infusum Taraxaci. — Infusion of taraxacum ( f ij — Oj). Dose, 
§ ss — § ij- (Not; official.) 

Mctractum Taraxaci Fluidum. — Fluid extract of taraxacum. Dose, 

3 J — S 3- 



URINO-GENITALS. 675 

Composition. — According to Kromayer, taraxacum contains tarax- 
acine y an amorphous, intensely bitter principle, and a crystalline sub- 
stance, taraxacerine. Nothing is definitely known as to the action of 
these substances. 

Actions and Uses. — Taraxacum possesses the properties of a sim- 
ple bitter, in that it promotes the appetite and digestion. It has 
been long held, both popularly and professionally, to possess the power 
to promote the flow of bile. Recent investigations have demonstrated 
the inaccuracy of these opinions. It is a mild laxative, and as such, 
doubtless, may cause by reflex stimulation an emptying of the gall- 
bladder. It is a diuretic, although not a very active one. It is still 
prescribed as a laxative in catarrhal jaundice, in ascites from hepatic 
disease, and in dyspepsia and indigestion associated with torpor of the 
liver. By German physicians, muriate of ammonia and dandelion are 
frequently associated together in the treatment of the affections above 
named. Taraxacum is occasionally used as a diuretic in dropsy, but 
its utility is very limited. 

The fluid extract of taraxacum is a good vehicle for the administra- 
tion of such remedies as the muriate of ammonia and quinine, the taste 
of which it somewhat covers. 

Scilla. — Squill. The bulb of Urginea scilla Steinheil (Nat. Ord. 
Liliacecv). (IT. S. P.) Ognon marin, Fr. ; Meerziciebel, Ger. 

Acetum Scillce. — Vinegar of squill ( 3 iv — Oij.) Dose, in, xx — 3 j. 

Syrupus Scillce. — Sirup of squill. Dose, 3 ss — 3 j. 

Syrupus Scillce Compositas. — Compound sirup of squill. Hive- 
sirup. This preparation contains squill, senega, and tartar-emetic, the 
last named in the proportion of one grain to the ounce. Dose, t\[ v — 3 j. 
This is a very active preparation, due chiefly to the tartar-emetic. 

Extractum Scilla} Fluidum. — Fluid extract of squill. Dose, t\[ j — 
ttj, v. 

Tinctura Scillce. — Tincture of squill. Dose, ttj, v — 3 ss. 

Composition. — The important constituent of squill is an acrid, bit- 
ter principle, scillitin, or skulein — which has not yet been isolated. 
According to Schroff, scillitin is a glucoside, and the active principle 
is an acrid, non-volatile substance (Fliickiger and Hanbury). 

Actions and Uses. — The taste of squill is bitter and somewhat 
acrid. It is an irritant to the mucous membrane, and excites nausea, 
vomiting, and purging, when introduced into the stomach in a suffi- 
cient dose. Very violent gastro-enteritis may be produced by its 
incautious administration in large doses. A state of hyperemia or 
inflammation of the gastro-intestinal mucous membrane, therefore, 
contraindicates its use. 

The active constituents of squill diffuse into the blood. Its sys- 
temic effects are produced by application to the external integument. 



676 EVACUANTS. 

Paralysis and convulsions are induced in warm-blooded animals by 
toxic doses ; and similar cerebral symptoms occur in man, in addition 
to the phenomena which usually attend the action of an irritant poison. 
In ordinary medicinal doses squill increases the bronchial mucus and 
facilitates expectoration. In toxic doses rapid breathing has usually 
occurred. It is highly probable that a portion of the active constituents 
of squill is eliminated by the broncho-pulmonary mucous membrane. 

Squill stimulates the functions of the kidneys and increases the 
urinary discharge when used in medicinal doses, but in excessive 
quantity it excites violent inflammation, with strangury and bloody 
urine. Suppression of urine may be a result of its irritating action on 
the kidneys. 

The use of squill is confined to its expectorant and diuretic effects. 
The acetum and syrupus scillce enter into the composition of expec- 
torant mixtures employed in the treatment of catarrh of the bronchial 
tubes, after the subsidence of acute symptoms, and the chronic forms 
of the disease. Squill is more particularly indicated when the sputa 
are tenacious, and are coughed up with difficulty. Ipecacuanha is ad- 
vantageously combined with it in the more recent cases. $ Acet. 
scilla?, § ss ; extract, ipecac, fluid., 3 ss ; tinct. opii deod., 3 j ; syrup, 
tolutan., 3 x. M. Sig. : A teaspooyiful every two, three, or four hours. 
I£ Scilla?, ipecac, aa, gr. vj ; ext. hyoscyami, gr. iij ; morphine sulph., 
gr. ss — gr. j. M. Ft. pil. no. xij. Sig. : One pill every four hours. 
In chronic bronchitis with emphysema or dilated right cavities of the 
heart, squill is better associated with the stimulating expectorants, 
ammoniac, asafoetida, benzoin, etc. 3 Syrup, scilla?, | ss ; tinct. opii 
camphor., 3 ij ; ammoniac, 3 ss ; syrup, tolu., 3 x. M. Sig. : A tea- 
spoonful as necessary. Squill is an improper remedy when there are 
present fever and an acute inflammatory condition of the air-passages. 

Squill is a very effective diuretic. Since in overdoses it will pro- 
duce great irritation of the kidneys, it is inadmissible in acute affec- 
tions of these organs. In dropsy caused by any of the chronic dis- 
eases of the kidneys, squill must be used with caution. As a diuretic 
this remedy is more especially useful in cardiac dropsy. It may be 
combined with digitalis or the saline diuretics. IJ Infus. digitalis, 
3 iijss; acet. scilla?, | ss. M. Sig.: A tablespoonful two or three times 
a day. $ Digitalis, 3]; scilla?, gr. x ; ext. colchici acet., 3j. M. Ft. 
pil. no. xx. Sig. : One pill every four or six hours. When anaemia is 
present, iron may be added to the above formula. £> Acet. scilla?, 
§ss ; liq. potassii citratis, f iijss. M. Sig. : A tablespoonful every 
four hours. 

Authorities referred to : 
Fluckiger and Hanburt. Pharmacographia. 
Husemann, Dr. Theod. Handbuch, zweiter Band, p. 11 75. 
Kohler, Dr. Hermann. Handbuch, p. 515. 



URINO-GENITALS. < 677 

Petroselinum. — Parsley-root. The root of Petroselinum sativum. 
(Pharm. 70.) (Not official.) 

Composition. — The most important constituent of parsley is apiol, 
an oily, non-volatile, yellowish liquid, having a distinctive odor and an 
acrid taste. It contains, also, a gelatinous substance, apiine (pectin ?), 
and a volatile oil. 

Actions and Uses. — Petroselinum has a hot, pungent taste, with 
an after acrid sensation. It is somewhat laxative — a property, doubt- 
less, dependent on the irritation which it produces. It is stimulant in 
its effects on the circulation, and promotes the cutaneous and bronchial 
secretions. It is diuretic, by reason of the local irritant action of the 
principles which are eliminated by the kidneys. 

Apiol has decided properties, and in its action strongly resembles 
quinine. It produces headache, tinnitus aurium, vertigo, intoxication, 
etc. 

Petroselinum is rarely employed for its diuretic effects. Its use is 
indicated in dropsy under the same conditions as juniper, squill, and 
other stimulating diuretics. It may be given in the form of infusion 
( 1 j — Oj)> one ^° three ounces at each dose. 

Apiol is a remedy of considerable value in the treatment of mala- 
rial diseases, but it is inferior in every respect to quinine. Its use is 
only justifiable in the treatment of inter 'mittents, and when the preju- 
dices or idiosyncrasies of the patient forbid the use of quinine. Fif- 
teen grains should be administered in one dose, or in divided doses, 
within an hour, in order to procure the maximum effect, and about 
four hours previous to the paroxysm. 

The evidence is conclusive that apiol has decided emmenagogue 
power. It is a stimulant to the uterine system, and therefore is con- 
traindicated in plethora of these organs, and should not be adminis- 
tered as an antiperiodic to pregnant women. It is indicated when a 
state of torpor of the ovaries and uterus exists. The amenorrhoea of 
anaemia, of functional inactivity, is the form of the malady in which 
apiol is serviceable. The condition of the blood should be corrected 
by iron, constipation should be removed by aloetic purgatives, and the 
apiol, in a considerable dose (fifteen grains), should then be adminis- 
tered at the time of the menstrual molimen, or just preceding the time 
when the flow should begin. If the case has been obstinate, a daily 
dose of apiol may be given for a week, or at least for several days be- 
fore the menstrual period. The neuralgic form of dysmenorrhoea is 
also benefited by this remedy. Other neuralgias are, it is said, relieved 
by apiol, but the existence of a malarial cause is, no doubt, the ex- 
planation of its curative action in such cases. 

Authorities referred to : 
Delorme, Dr. Gazette des Hopitaux, 1860, p. 511. 
Joret and Homolle. Bulletin General de Therapeuiique, vol. xlviii, p. 32. 



678 EVACUANTS. 

Marotti, Dr. Ibid., 1863, p. 295. 

Stille, Dr. A. Therapeutics and Materia Medica, vol. ii, p. 631. 

Polygonum Hydropiperoides. — Water - pepper. This indigenous 
plant is not recognized by the United States Pharmacopoeia. A fluid 
extract prepared according to the general directions of the United 
States Pharmacopoeia may be prescribed in the dose of ttj, x to 3 j. A 
solid extract is also to be found in the shops — dose, gr. j — gr. v. 

Actions and Uses. — The taste of hydropiper is hot, pungent, and 
acrid. The juice excites inflammation and vesication when applied to 
the external integument. In medicinal doses it causes a sensation of 
warmth in the stomach, and a " peculiar tingling sensation throughout 
the whole system" (Eberle). Unless given in an overdose it does 
not excite vomiting or produce purging. It stimulates the heart and 
arteries, increases the warmth of the surface, and promotes the cuta- 
neous, bronchial, and renal secretions. It stimulates the menstrual 
flow, and is aphrodisiac. 

This indigenous but little known remedy is a very efficient stimu- 
lating diuretic and emmenagogue. The author can confirm the state- 
ment of Eberle, who reports that " with no other remedy or mode of 
treatment has he been so successful as with this," in amenorrhcea. It 
is adapted to cases of amenorrhcea due to functional inactivity or tor- 
por of the uterine system, and is contraindicated when a condition 
of plethora or congestion exists. The administration of this remedy 
should be begun about a week before the menses ought to appear. 
Thirty minims of the fluid extract should be administered four times 
a day. If anaemia exist, iron should be given ; if constipation, aloes. 

Hydropiper is a remedy of considerable power in functional impo- 
tence. When the erections are feeble, the seminal fluid watery, and the 
testes soft, good results will be obtained from the use of this remedy, 
provided no structural alterations hinder or prevent improvement. 

When hydropiper is administered in these disorders of the sexual 
system, it causes a feeling of weight and tension, and dragging of 
the pelvic viscera. As it tends to increase the blood-supply to these 
organs, it is inadmissible when a state of congestion or inflammation 
exists. 

Authorities referred to : 

Eberle, Dr. John. A Treatise of the Materia Medica and TJierapeutics, fourth edi- 
tion, vol. i, p. 441 . 

Porcher, Dr. F. Peyre. Resources of the Southern Fields and Forests, p. 409. 

Rllta. — Rue. The leaves of Ruta graveolens (Pharm. 70, not official). 

Composition. — The medicinal activity of this plant depends on the 
presence of a volatile oil. Only the fresh leaves should be employed, 
and, as drying impairs the quality of the drug, the oil should be pre- 
scribed. 






URINO-GENITALS. 679 

Oleum Rutce. — Oil of rue. This is a volatile oil, of a greenish- 
yellow color, very disagreeable and characteristic odor, and pungent, 
acrid taste. Dose, lU j — v\ v. 

Actions and Uses. — In its local action rue is an irritant ; applied 
to the skin, the oil causes heat, inflammation, and vesication. In ordi- 
nary medicinal doses a sensation of warmth follows its introduction 
into the stomach, and increased action of the heart and arterial system 
and a subjective feeling of peripheral heat are subsequently produced. 
The cutaneous, bronchial, and urinary excretions become more abun- 
dant, and the odor of the volatile oil is apparent in the breath, the sweat, 
and the urine. In toxic doses the oil of rue produces violent gastro- 
enteritis, prostration, convulsive muscular movements, hebetude of 
mind, etc., strangury and suppression of urine. In women the use of 
rue increases the menstrual flow, and large doses may cause abortion 
to take place. In men this agent promotes the sexual appetite, and 
increases the vigor of the erections. 

A tincture of the oil of rue is an efficient carminative and antispas- 
modic remedy in the flatulent colic and hysteria of women. Almost 
the only use of rue at present is in the treatment of amenorrhcea. It 
is one of the most efficient emmenagogues. Plethora, congestion, or 
inflammation of the pelvic viscera, contraindicate its use. Functional 
inactivity of the ovaries and uterus is the condition which justifies the 
employment of rue. It has been recommended in menorrhagia when 
the vascular tonus is low, and in uterine hcemorrhage after miscar- 
riage. It need hardly be remarked that the condition of pregnancy 
forbids the use of rue. 

Sabina. — Savine. The tops of Juniperus sdbina Linne (Nat. Ord. 
Conifer w). (U. S. P.) Sabine, Fr. ; Sabenhraut, Ger. 

Composition. — Savine contains an essential oil, in the proportion 
of two to two and a half per cent in the tops and about ten per cent 
in the berries. The oil of savine is isomeric with the oil of turpentine. 

Oleum Sabinaz. — Oil of savine. Dose, hi j — tij, v. 

Mxtractum Sabince Fluidum. — Fluid extract of savine. Dose, tt], v 
— nt xv. 

Actions and Uses. — Savine has a strong, disagreeable odor, and a 
pungent, acrid taste. Applied to the skin, the oil causes inflammation 
and vesication, if the contact be sufficiently prolonged. Introduced 
into the stomach in a full medicinal dose, a sensation of heat, eructa- 
tions tasting of the oil, flatulence, and nausea, are produced. A toxic 
dose sets up a violent gastro-enteritis. The oil diffuses readily into 
the blood, and is excreted by various channels — the breath, the sweat, 
and the urine smelling strongly of it. Increased action of the heart 
and a rise of tension of the arterial system, followed by diminished 
tonus of the vessels, result from its administration in full medicinal 



680 EVACUANTS. 

doses. The cutaneous, bronchial, and urinary excretions are rendered 
more abundant by savine. Strangury and bloody urine are caused by 
it in overdoses. The evidence is conclusive that savine exerts a pow- 
erful influence on the uterine system. It increases the menstrual flux, 
and in toxic doses may originate uterine action and cause abortion. 
The abortifacient effect can not be obtained unless by the administra- 
tion of a quantity sufficient to endanger life. 

The only use to which savine is now applied is in the treatment of 
amenorrhcea. It is generally conceded that the estimate of its pow- 
ers made by Pereira is not extravagant, namely, that "it is the most 
certain and powerful emmenagogue of the whole materia medica." 
Savine is indicated in amenorrhoea dependent on deficient activity of 
the sexual system, accompanied by general atony. It is inadmissible 
when a tendency to congestion of the pelvic viscera is present, or in a 
condition of general plethora. Cases of dysmenorrhoea are benefited 
by savine when the subject is of relaxed habit, the menstrual flow be- 
ing scanty, provided narrowing of the cervical canal is not the cause 
of the painful and difficult menstruation. Menorrhagia, when due to 
an enlarged, relaxed, and passively congested uterus, and haemorrhage 
after abortion, may sometimes be arrested by this agent. 

The most effective preparation of savine is the oil. This may be 
prescribed in gelatin-capsules, in an emulsion, or in pilular form. The 
fluid extract, if made from the fresh tops, is an excellent preparation. 
Combination with other remedies of the same group increases the action 
of savine. $ 01. sabinse, 3 j ; ol. rutse, 3 j ; tinct. polygon, hydropi- 
per, § j ; ol. amygdal. express., mucil. acacise, aquae menth. pip., aa 3 ij. 
M. Sig. : A teaspoonful twice or three times a day as an emmenagogue. 

Authorities referred to : 

Aran, M. Bulletin General de Therapeuiique, vol. xxx, p. 61. 

Beau, M. Le Dr. Ibid., vol. xliii, p. 140. 

Flucker and Hanbury. Pharmacographia. 

Husemann, Dr. Theodor. Handbuch, zweiter Band, p. 1200. 

Kohler, Dr. Hermann. Handbuch, p. 387. 

Taylor, Dr. A. S. On Poisons, third edition, London, p. 494. 

Van de Warker, Dr. Ely. The Detection of Criminal Abortion, 1872. 

Cantharis.— Cantharides. Cantharis vesicatoria. Cantharide, Fr. ; 
Spanische Fliegen, Ger. 

Tinctura Cantharidis. — Tincture of cantharides. Dose, tu ij — ttj, xv. 

(The other preparations of cantharides, which are used externally 
only, will be taken up in Part III of this work.) 

Composition. — The principal constituent of cantharides is a neu- 
tral, crystallizable principle, cantharidin. It contains also an oil, fatty 
matter, and an odorous material. 

Antagonists and Incompatibles. — There is no chemical or physio- 



URINO-GENITALS. 681 

logical antagonist to cantharides. Poisoning by this substance should, 
therefore, be treated on general principles. The stomach should be 
evacuated by emetics or the stomach-pump ; mucilaginous substances 
should be freely administered ; the gastro-enteritis should be treated 
by opium, etc. 

Synergists. — Oils and fats increase the solubility and favor the 
absorption of cantharidin. The physiological actions of this agent are 
promoted by the other members of this group. 

Physiological Actions. — The odor of cantharides is nauseating, 
fetid, and peculiar. In contact for a sufficient time with the skin or 
mucous membrane, it excites considerable burning, inflammation, and 
vesication. In the stomach it causes a sensation of heat, severe gas- 
tralgia, nausea, and vomiting. Notwithstanding the insolubility of 
cantharidin, it readily diffuses into the blood. It is actively stimulating 
to the circulatory system, and a rise of temperature, with thirst, follows 
in an hour or two. Under these circumstances, the urine becomes 
scanty and burns the passages ; severe pain is experienced in the back 
and loins ; priapism occurs ; and the urine, voided with great difficulty, 
frequently contains albumen and blood. To this excitement of the 
circulatory system and of the genital organs succeeds a condition of 
depression, in which the pulse falls, the arterial tension is lowered, 
and the temperature declines (Radecki). 

When a toxic dose is swallowed, in a short time a sense of constric- 
tion of the oesophagus, with difficulty of swallowing, and ptyalism, 
occur. Intense gastric pain, vomiting of glairy mucus streaked with 
blood, intestinal pain, abdominal tenderness, tenesmus, and mucous 
and bloody stools, are produced. Violent irritation of the genito-uri- 
nary organs is also experienced, manifested by lumbar pain, strangury 
and bloody urine, priapism, swelling and inflammation of the external 
genitals. In most cases of poisoning by cantharides, cerebral effects, 
consisting of muscular trembling, partial or general convulsions, coma, 
and insensibility are produced. Abortion has been caused by toxic doses 
of cantharides, and after death violent metro-peritonitis, gastro-enteri- 
tis, and general peritonitis, have been observed. It is questionable 
whether abortion can be caused by a dose less than toxic. 

Cantharides has frequently caused dangerous symptoms, when used 
with a view to induce venereal excitement. That it does promote the 
sexual appetite is probably true, but this result is accomplished only by 
the use of a quantity sufficient to cause vascular turgescence of the 
sexual organs. 

Therapy. — In acute desquamative nephritis, after the subsidence 
of the acuter symptoms, good results are obtained from cantharides. 
The local condition in which this remedy is serviceable consists in 
hyperemia with loss of vascular tonus. Chronic pyelitis and chronic 
catarrh of the bladder are occasionally remarkably benefited by the 



682 EVACUANTS. 

long-continued use of small doses of cantharides. Irritability of the 
bladder, more especially as it occurs in women, without the existence 
of acute inflammation, and not produced by uterine displacements, is 
sometimes quickly and entirely relieved by this remedy. The irritable 
state of the bladder and the vesical tenesmus, which accompany chronic 
prostatic disease, are also sometimes surprisingly relieved by canthari- 
des, but the author is unable to indicate the special circumstances to 
which it is adapted. 

Gleet and prostorrhoea are benefited by cantharides when these 
maladies occur in subjects of a relaxed fiber, with feeble circulation. 
Ringer makes the extraordinary statement that one drop of the tincture 
given three times a day will prevent chordee. 

When spermatorrhoea actually exists, and is due to deficient tone of 
the seminal vesicles, the erections being feeble, and the sexual feeling 
torpid, good results are obtained by the use of cantharides. In cases 
of scanty menstruation, occurring in womeu of lax fiber, with cold 
hands and feet, improvement follows the use of this remedy. It some- 
times happens that menorrhagia is due to relaxed vessels and a general 
lowering of the vascular tonus : under such circumstances cantharides 
may render important service. In these disorders of the sexual system, 
characterized by deficient power, the good effects of cantharides are 
promoted by the use of iron. The tincture of cantharides is the most 
eligible preparation for internal administration. In chronic affections 
of the genito-urinary passages the dose will range from five to fifteen 
drops, rarely the latter, three times a day. 

Authorities referred to : 

Casper's Practisches Handbuch der gerichtlichen Medicin, by Liman, zweiter Band, 
p. 576. 

Husemann, Dr. Theod. Handbuch, zweiter Band, p. 538, et seq. 

Radecki, Fr. Die Cantharidinvergiftung. Inaug. Diss. Schmidt's Jahrbucher, vol. 
cxxxviii, p. 17. 

Ringer, Dr. Sydney. Handbook of Therapeutics. 

Taylor, Dr. A. S. On Poisons, fourth edition, London, p. 524. 



PAET III. 

TOPICAL REMEDIES. 



COUNTER-IRRITANTS. 

Exteenal irritation, utilized for the relief or cure of internal 
maladies, is entitled counter-irritation. The remedies employed for 
this purpose are divisible into two groups : 

1. Rubefacients ; 

2. Epispastics. 

A rubefacient is a remedy which causes heat and redness ; but, if 
the contact with the skin be sufficiently prolonged, vesication may be 
produced. An epispastic is a remedy which excites inflammation and 
vesication. The first group of remedies are restricted in their applica- 
tion to such therapeutical results as can be attained by a superficial and 
temporary action in the skin. The second group are intended for 
more permanent action and a deeper impression on internal organs. 
These remedies differ not only in the degree, but in the character of 
the effects produced. An impression on the periphery induces some 
kind of molecular modification at the center. According as the im- 
pression is slight or severe are the centric modifications localized to 
the point of reception or transferred to distant points (reflex impres- 
sions). According to the severity of the peripheral impression are 
the resulting local centric disturbance and the reflex changes (trophic 
alterations). Thus a slight peripheral rubef action may cause a trivial 
centric vascular spasm, but an extensive burn on the body may induce 
vaso-motor paresis, and consequent inflammatory changes in remote 
organs. 

RUBEFACIENTS. 

Sinapis Alba. — White mustard. The seed of Sinajns alba, Linne 
(Nat. Ord. Cruciferce). (IT. S. P.) 

Sinap>is Nigra. — Black mustard. The seed of Sinapis nigra. 

Charta Sinapis. — Mustard-paper. 

Composition. — When water is added to pulverized black mustard, 
pungent, irritating fumes are given off. These fumes consist of the 
volatile oil of mustard (allyl sulphocyanide). This volatile oil is pro- 



684 TOPICAL REMEDIES. 

duced by a reaction between certain constituents of the seeds — sini- 
grin (myronate of potassium) and myrosin — in presence of water, and 
at a temperature below 100° Fahr. The boiling-temperature destroys 
the ferment, myrosiu, and hence prevents the formation of the volatile 
oil. Mustard contains also a bland fixed oil, which may be procured 
by expression. 

White mustard contains an indifferent, crystalline substance, sinal- 
bin, and myrosin. Sulphocyanate of acrinyl, a product of the reac- 
tion between sinalbin and myrosin, is the rubefacient principle of white 
mustard (Fliickiger and Hanbury). White mustard contains also an 
alkaloid — sinapine. The chemical composition of the two kinds of 
mustard is, it will be seen, closely analogous. Myrosin exists in white 
mustard in larger proportion than in black, hence a considerably larger 
quantity of the volatile oil of mustard is formed when an addition of 
white mustard is made to the black. 

A great variety of plasters and liniments (some referred to already 
in their appropriate connections) are employed to induce a rubefacient 
action. 

EHPLASTRA. 

Emplastrum Capsici. — Capsicum plaster (a resin plaster on which 
is spread a thin layer of oleo-resin of capsicum). 

Emplastrum Pesince. — Resin plaster (resin, lead plaster, and yellow 
wax). 

Emplastrum Baponis. — Soap plaster (soap, 10 parts ; lead plaster, 
90 parts). 

Emplastrum Arnicce. — Plaster of arnica (extract of arnica, resin 
plaster). 

Emplastrum Picis Burgundicm. — Burgundy-pitch plaster (Bur- 
gundy pitch, 90 parts ; yellow wax, 10 parts). 

Emplastrum Picis Canadensis. — Canada-pitch plaster (Canada 
pitch, 90 parts ; yellow wax, 10 parts). 

Emplastrum Picis cum Cantharide. — Plaster of pitch with can- 
tharides (Burgundy pitch, 92 parts ; cerate of cantharides, 8 parts). 

LINIMENTA. 

Linimentum Calcis. — Lime liniment (equal parts of lime solution 
and cotton-seed oil). 

Linimentum Cantharidis. — Cantharides liniment (cantharides, 15 
parts ; turpentine, q. s. to make 100 parts). 

Linimentum Sinapis Compositum. — Compound mustard liniment 
(volatile oil of mustard, extract of mezereum, camphor, castor-oil, and 
alcohol). 

Linimentum Ammonim. — Liniment of ammonia (water of ammonia, 
30 parts ; cotton-seed oil, 70 parts). 



EPISPASTICS. 685 

Linimentum Camphor ce. — Liniment of camphor (camphor, 20 
parts ; cotton-seed oil, 80 parts). 

Linimentum Saponis. — Soap liniment (soap, 10 parts ; camphor, 5 
parts ; oil of rosemary, 1 part ; water, q. s.; alcohol, 70 parts). 

Linimentum Terebinthince. — Liniment of turpentine (resin-cerate, 
65 parts 5 oil of turpentine, 35 parts). 

An excellent rubefacient for long-continued use and moderate ac- 
tivity is the domestic spice-bag. This consists of a mixture in equal 
parts of cloves, cinnamon, allspice, ginger, and a half pint of capsicum, 
sewed into a flat bag. When required for use, it is dipped in vinegar 
or whisky, and laid over the affected region, usually the abdomen. A 
piece of flannel or spongio-piline may be moistened with the tincture 
of these aromatics, and applied for the same purposes. 

A turpentine-stupe, which is one of the most frequently-used ex- 
temporaneous counter-irritants, is made as follows : A piece of flannel 
folded in several layers, or a piece of spongio-piline, is wrung out in 
hot water, and a few drops (live to fifteen) of turpentine are sprinkled 
over it. This is placed over the affected region, and is confined by a 
towel or napkin pinned around the part. Turpentine, applied in this 
way, is a very active rubefacient, and may even vesicate, so that atten- 
tion is required to avoid overaction. 

EPISPASTICS. 

Ceratum Cantharidis. — Cantharides or blistering cerate. 

Ceratum Extracti Cantharidis. — Cerate of extract of cantharides. 

Charta Cantharidis. — Cantharides-paper. 

Collodium cum Cantharide. — Collodion with cantharides. 

Linimentum Cantharidis. — Liniment of cantharides. 

Firing. — By the method of firing, merely rubefacient or vesicating 
effects are produced. Firing is accomplished by the application of an 
iron disk provided with a suitable handle (Mayer's hammer). It is 
dipped into boiling water, and then passed, more or less rapidly, over 
the skin of the part to be acted on. Very brief contact suffices to 
vesicate, and this is the usual effect of the application. 

Of the above preparations the most efficient is the ceratum extracti 
cantharidis, the most elegant the charta cantharidis, and the most 
convenient the collodium cum cantharide. The cerates should be 
spread on adhesive plaster, leaving a margin of the plaster to secure 
adhesion to the skin. Before the application of a blister, if prompt 
action is necessary, a mustard-plaster should be laid on long enough to 
produce rubefaction, or the skin should be rubbed with turpentine. 
When the skin is very thin and sensitive, the blister should be covered 
with tissue-paper. When the vesication is to be permitted to heal in 
a short time, or when young and irritable subjects are to be blistered, 
the cantharides-plaster should be removed when distinct redness of the 



686 TOPICAL REMEDIES. 

skin is produced, and a poultice applied, which will develop the vesi- 
cles. The length of time required for a blister " to draw " is influ- 
enced by the age of the subject and the condition of the skin. From 
two to twelve hours, as a rule, will elapse before vesicles appear ; and, 
when a very deep impression is intended, the blister may remain even 
twenty-four hours. In infants and in certain states of the constitution 
(scorbutus, purpura, scarlatina, etc.), prolonged contact of a canthari- 
des-plaster may cause deep sloughing and very severe nervous symp- 
toms, and adynamia. 

When the vesicles are fully developed, they should be punctured at 
the most dependent point, and the serum, as it escapes, absorbed by a 
soft cloth. If the blistered surface is to be allowed to heal, a dressing 
of raw cotton suffices. If discharge is to be encouraged, resin-cerate 
or savine-cerate may be applied, spread on a cloth perforated to permit 
the discharge to exude, and covered with raw cotton to absorb the 
fluid. If the blister is slow to heal, boracic-acid lotion is an efficient 
application, or a weak lead-lotion may be used. 

The Theory of Counter-Irritation. — When the skin is irri- 
tated, by a mustard- plaster, for example, the superficial vessels of the 
part dilate, and an increased amount of blood is present in them. For 
a short distance around the part irritated, also, more or less dilatation 
of the vessels takes place. In this way a small amount of blood may 
be temporarily imprisoned. The influence which the retention in an 
external part of so small an amount of blood has on the general circu- 
lation, must be very slight. The obvious relief often afforded by a 
mustard-plaster can hardly, therefore, be ascribed to this limited with- 
drawal of blood. 

An irritation established in the neighborhood of a part in which a 
morbid action is proceeding may, by reason of the contiguity of the 
tissues, affect the vascular supply to the diseased textures. TIM irri- 
tatio y ibi fluxus ; but, in order that the fluxion shall modify diseased 
action, it is necessary that there be a continuity of the vascular con- 
nections. The method of Furneux Jordan, which consists in the appli- 
cation of the counter-irritant to the neighboring vascular area, is based 
on this principle. 

An irritation which consists in a local fluxion, and a state of altered 
sensibility in the nerves of the part, may affect the functions of distant 
organs. Counter-irritation applied to a considerable surface increases 
the action of the heart, raises the temperature of the body, and exalts 
the irritability of the nervous system. These are the general or sys- 
temic effects. Distinctly-localized results are also produced. When 
one hand is immersed in cold water, a positive fall of temperature takes 
place in the other. Irritation of the lumbar region, as Brown-Sequard 
has shown, is followed by contraction of the vessels of the kidneys. 
Extensive injury to the surface of the body, by burning or scalding, 



EPISPASTICS. 687 

may excite ulcerative action in the duodenum, or may set up a pneumo- 
nia. Injury to a motor-nerve trunk may be followed by ascending neu- 
ritis, and serious atrophic changes in the multipolar ganglion-cells of 
the anterior columns. It follows from these facts that an irritation of 
the surface which involves the end-organs of the nervous system will 
affect the caliber of the arterioles and modify the functions of the 
trophic nerves. In these results we find a rational explanation of the 
methodus medendi of counter-irritation. 

Certain other physiological laws deserve attentive consideration in 
this connection. An irritation which first produces a tetanic state of 
the vaso-motor nervous system may, if too long continued, exhaust the 
irritability of the organic muscular fiber, and cause paresis. Moderate 
irritation will exalt the functional power of the trophic centers ; but 
excessive and long-continued injury to the surface may set up atrophic 
changes (ulcer of duodenum from burn). In these physiological facts 
also we find a rational explanation of the injury not unfrequently done 
by too powerful or too protracted counter-irritation. 

Vesicants, in addition to the effects of counter-irritants sketched 
above, cause an exudation of serum. This exudation may have a two- 
fold effect : 1. To lessen the gross amount of the blood-serum, and 
thus diminish the blood-pressure ; and, 2. To remove toxic or patho- 
logical materials from the tissues and fluids of the inflamed part. More 
powerful systemic effects are produced, and vaso-motor paresis and 
trophic changes are more quickly induced, by blisters than by rubefa- 
cients. 

Therapy. — Various methods of counter-irritation are employed in 
the treatment of diseases of the abdominal viscera. For the relief of 
nausea, vomiting, diarrhoea, colic, cholera-morbus, etc., no expedient is 
more generally useful than a mustard-plaster. In persistent vomiting, 
a small blister applied to the epigastrium will often afford permanent 
relief. The good effects of a blister in such cases are enhanced by 
dusting over the exposed derma some powdered morphine. In acute 
inflammatory affections — typhlitis, peritonitis, puerperal peritonitis, 
pelvic cellulitis, etc. — the best results are obtained by the use of tur- 
pentine-stupes during the acute stage, and the application of blisters 
after the acuter symptoms have subsided. The prolonged contact of 
blisters with the abdominal wall of thin subjects has set up peritonitis 
by contiguity of structures. The author has observed instances of 
this kind, and analogous cases have been reported. 

In chest-diseases — pleuritis, pneumonia, pericarditis, etc. — some 
form of counter-irritation is invariably employed, and is often greatly 
abused. At the onset of these maladies a large mustard-plaster to the 
chest, allowed merely to redden the skin, is an excellent expedient ; 
during the progress of the inflammation the turpentine-stupe is gener- 
ally the best application ; to assist in the process of resolution and re- 



688 TOPICAL REMEDIES. 

pair, the more permanent action of a blister will be serviceable. Much 
has been said about the " blistering-point " in pneumonia. The discus- 
sion is resolvable into this : during the inflammatory stage, blisters are 
harmful, because they stimulate the nervous and vascular system, and 
are useful when the crisis occurs, to assist in the liquefaction and ab- 
sorption of inflammation products. At the very inception of an acute 
thoracic disease a flying blister may render the same service as a mus- 
tard-plaster, but it possesses no advantage over the latter. A succes- 
sion of " flying blisters " appears to be useful in hydrothorax, to pro- 
mote absorption. 

Counter-irritants are much abused in the treatment of phthisis at 
its various stages. The chest-pains which accompany this disease can 
usually be relieved by mustard and belladonna plasters. Intercurrent 
attacks of pleuritis and pneumonia may be treated by the milder forms 
of irritation. The pustulation of the chest with croton-oil or tartar- 
emetic ointment is rarely if ever justifiable, and deep blistering is al- 
ways harmful. 

In acute inflammation of the meninges, cerebral or spinal, blisters 
are often employed, but there is singularly little proof of their utility. 
When used, they should be confined to the mastoid processes or to 
the nape of the neck. Under no circumstances is it ever justifiable to 
shave and blister the scalp, as was formerly not unfrequently done in 
various forms of cerebral disease. An aura proceeding from an ex- 
tremity may be intercepted, and attacks of epilepsy averted, by encir- 
cling the limb with a strip of blistering-plaster. Various instances of 
the success of such a blister have been reported. Hysterical paraly- 
sis is most successfully treated by encircling the affected extremity 
with narrow blisters (Reynolds), and hysterical aphonia may some- 
times be very quickly cured by a blister to the larynx. The curative 
effect of such an application is doubtless due to the moral impression 
of the counter-irritant. Blisters over the course of the affected nerve 
are of great service in neuritis. The good effect of the blisters is in- 
creased by treating the blistered surface with morphine. There can be 
no doubt of the curative value of blisters in neuralgice. According to 
Anstie, it is not the mental impression produced by the pain of the 
blister, and not the withdrawal of serum from the focus of pain, which 
explain their efficacy, but they act " as true stimulants of nerve-func- 
tion." The best point at which to apply the blister is " as close as may 
be to the intervertebral foramen from which the painful nerve issues." 
Flying blisters are to be preferred, and, as a rule, exudation of serum 
is not to be encouraged. 

Lumbago, myalgia, and fugitive but recurring muscular pains, are 
sometimes relieved by the warming plasters given at the head of this 
article, or by frictions with ammonia-liniment, turpentine-liniment, etc. 

Blisters are, as a rule, inadmissible in acute affections of the kid- 



EPISPASTICS. 689 

neys and bladder. A succession of blisters to the perinseum is unques- 
tionably serviceable in chronic prostatitis and in gleet. 

Inflammatory affections of the eye and ear are, as a rule, benefited 
by the application of blisters in the neighborhood of these organs. 

The application of blisters is an effective method of treating acute 
rheumatism. According to the plan of Davies and Dechilly, the 
affected joints are enveloped in blisters, which are allowed to remain 
until thorough vesication is produced and serum is abundantly dis- 
charged. The author, who has had considerable experience in the 
treatment of rheumatism by this method, finds that a number of small 
blisters applied around the joint are as effective and less painful. The 
good effects of the blister-treatment are these : the pain and swelling 
are abated, the danger of cardiac complication lessened, and the dura- 
tion of the disease shortened. It is a singular fact that the urine be- 
comes neutral or alkaline under the action of blisters. The curative 
effect of blisters is not, probably, to be ascribed to the withdrawal of 
acid serum from the affected joints, but rather to an influence exerted 
through the trophic nerves on the metamorphosis of tissues. 

As general stimulants, rubefacients and vesicants are employed to 
arouse the vital processes in a condition of great depression or col- 
lapse from any cause, e. g., cholera, pernicious malarial fever, urazmia, 
narcotic poisoning, etc. 

Contraindications of Blisters. — The acute stage of an inflam- 
mation ; pregnancy ; scorbutus and purpura ; infancy ; debility ; are 
conditions rendering their use improper and injurious. 

The strangury produced by blisters is lessened by the free use of 
diluent drinks, and is relieved when it occurs by an enema of lauda- 
num or the hypodermatic injection of a minute quantity of morphine. 
A decoction of uva-ursi freely drunk will, it is said, prevent strangury, 
but the effect of this remedy is, probably, not greater than that of an 
ordinary diluent. 

The method of " firing " is sometimes very beneficial in neuralgia, 
spinal irritation, myalgia, etc. The effects can be regulated by the 
temperature of the hammer, and by the duration of the contact with 
the skin, and may vary in severity from the mildest rubefaction to 
vesication, and even destruction of the skin. 

Acupuncture. — Needles about three inches in length, and having 
a red wax, hard-rubber, or metal head, are employed for this purpose. 
They are introduced by a rapid rotary motion. Insulated needles are 
used in the same way for conveying the galvanic current to deeply- 
placed nerves. 

Baunscheidtismus. — This is a form of acupuncture, so named from 

Baunscheid, its inventor. " The instrument employed consists of a 

heavy disk, about half an inch in diameter, having inserted into it 

about twenty-five sharp needles, each about nine-sixteenths of an inch 

44 



690 TOPICAL REMEDIES. 

in length. To this disk a strong wire spiral spring (five and a half 
inches in length) is attached, and the other extremity of the spring is 
inserted into an elongated spindle-shaped handle." The spring and 
needles are contained in a cylinder, the handle attached. The follow- 
ing is the mode of using it : the open extremity of the cylinder is 
placed firmly on the skin ; the handle is then drawn up, which com- 
presses the spring ; now, if suddenly loosed, the recoil of the spring 
drives the needles smartly into the skin. The punctures maybe rubbed 
with a weak mixture of croton-oil, with cajeput-oil, or other suitable 
counter-irritant. 

Actions and Uses. — These are methods of counter-irritation which 
appear to possess peculiar powers. The theories which have been pro- 
posed to explain their mode of action are far from satisfactory. The 
method of Baunscheid is that of an ordinary counter-irritant added to 
the effects of acupuncture ; but no explanation has hitherto been offered 
which accounts, in a rational manner, for the curative effects of acu- 
puncture in certain maladies. 

In tic-douloureux, sciatica, lumbago, and myalgia, it occasionally 
happens that remarkable and instantaneous relief is obtained by the 
insertion of acupuncture-needles. 

When the patient is timid, the sensibility of the skin may be dimin- 
ished by the application of chloroform for a minute, or of the ether- 
spray. If rapidly rotated by the finger and thumb, the needle will 
penetrate with little suffering. 

Aquapuncture. — The method of aquapuncture consists in the in- 
troduction of water subcutaneously, or into the substance of muscles. 
A special instrument has been invented for this purpose, the advan- 
tage of which consists in its being armed with several needles, which 
permit the introduction of the water at various points simultaneously. 
Ordinarily, the hypodermatic syringe will suffice for the performance of 
this little operation, and, if patients object to repeated punctures, the 
sensibility of the skin may be obtunded by ether-spray. 

When water is injected under the skin, more or less pain, accom- 
panied by burning, is produced. A wheal is formed about the site of 
the puncture, and redness of the skin and elevation of the temperature 
at that point follow. It is a remarkable circumstance that aquapunc- 
ture has the power to relieve pain in a superficial nerve. So decided 
is this effect that there are physicians who hold that the curative effect 
of the hypodermatic injection of morphine is due, not to the morphine, 
but to the water ! In order that aquapuncture shall relieve pain, it is 
necessary that the water be injected into the neighborhood of the pain- 
ful nerve. Injection at a remote and indifferent point would certainly 
fail of any effect except that reflex effect which is produced by any 
counter-irritant. Aquapuncture, however, has unquestionable power 
as a counter-irritant. 



BLOODLETTING. 691 

The method of aquapuncture has been employed with success, 
which must be regarded as extraordinary, in neuralgia}, facial, sciatic, 
and lumbo-abdominal ; in lumbago, irritability of the bladder, uterine 
colic, gastralgia, etc. The author has produced excellent effects from 
the injection of water into paralyzed and wasting muscles. It promotes 
the nutrition of muscles, and contributes to the regeneration of volun- 
tary power. In the various cases to which this treatment is appli- 
cable, the quantity which should be injected will vary from thirty 
minims to a drachm. When the first injection does not relieve in two 
minutes, another should be practiced. It is insisted upon (Lafitte) that 
the water be injected at the painful points (points douloureux). There 
need be no limit to the number of the injections, if they afford relief : 
for, of course, no injury will result, unless it be the production of an 
abscess at the site of the injections, which is very rare. 

Authorities referred to : 

Anstie, Dr. F. E. On Neuralgia and the Diseases that resemble it, London and New 
York, 1871, p. 192, et seq. 

Ibidem. Tlie Practitioner. On the Theory of Counter-Irritation, vol. iv, p. 156. 

Bennett, Dr. James Bisdon. Remarks on Counter-Irritation. The Practitioner, vol. 
ii, p. 321. 

Davies, Dr. Herbert. The Lancet, vol. ii, 1865. 

Dickinson, Dr. W. H. On the Practice of Counter-Irritation, The Practitioner, vol. 
iii, p. 97. 

Dieulafoy, Dr. Georges. Nov. Diet, de Med. el de Chirurg. Prat., article Douleur. 

Lafitte, Dr. Leopold. V Union Medicale, October 5, 1875. 

Delut, Dr. Ibid. 

Boss, Dr. James. On Counter-Irritation. The Practitioner, vol. iv, p. 73. 

Servajan, Joannes. De V Aquapuncture, Paris, 1872, pp. 56. 

BLOODLETTING. 

Venesection, arteriotomy, cupping, leeching. — The manner of bleed- 
ing, whether by opening a vein or an artery, is a surgical subject, 
which it is not necessary to consider in this work. 

Physiological Actions. — Bloodletting may be employed for a 
systemic or local effect. Bleeding from a vein or an artery, by dimin- 
ishing the whole quantity of the circulating fluid, and by altering its 
quality, affects the functions of every organ, and especially of organs 
the seat of an acute hyperemia. Cupping and leeching, if carried far 
enough, may diminish the general blood-pressure and the proportion of 
the morphotic elements ; but their action is largely local and revulsive. 

The effects of bloodletting on the composition of the blood are 
these : the water is increased and the globules, fibrin, and salts are 
diminished in relative amount ; an artificial anaemia is thus induced. 
The action of the heart becomes more rapid and its force lessened ; 
the arterial tension falls, and the pulse assumes the dicrotic character. 
The functions of organs, especially of the brain and nervous system, 



692 TOPICAL EEMEDIES. 

lose energy. Nausea, vomiting, faintness, syncope, and epileptoid seiz- 
ures occur, when the loss of blood is considerable. Epileptiform con- 
vulsions is a constant phenomenon in animals bled to death (Kussmaul 
and Tenner). 

When the quantity of fluid in the vessels is lessened by bleeding, 
thirst is experienced, and absorption is more rapid ; the sensibility to 
pain is diminished, probably, because the perceptive centers are func- 
tionally inactive ; and the power to evolve force, muscular, digestive, 
nervous, etc., is greatly restricted. Only one function, therefore, is 
rendered more active by bleeding ; all the others are depressed in con- 
sequence of the inadequate supply of nutrient material. 

It is a remarkable fact, perfectly well known to old practitioners, 
and to which Sir James Paget has recently called attention, that the 
ill effects of bleeding, in healthy subjects, are very temporary and 
easily repaired. The blood-globules, which are relatively more affected 
by bleeding than the other constituents, are quickly reproduced, and 
the functions of organs suddenly very much depressed soon recover 
their normal energy. That any permanent injury is done to the 
healthy human system by a moderate bleeding seems, therefore, to be 
highly improbable. 

Therapy. — The limits of this work will not permit the introduc- 
tion of any controversial discussions. The author is to be ranked with 
those who do not employ general bloodletting, but he does not deny 
that it is occasionally useful ; and that, indeed, it may be indispensa- 
ble. A summary of the physical conditions in which venesection may 
be useful or indispensable should not, therefore, be omitted from a 
work on therapeutics. 

The therapeutical effect of a general bloodletting in congestion and 
inflammation is largely mechanical. In acute congestion of the lungs, 
when aeration of the blood is seriously impeded ; when there are ex- 
tensive stasis on the venous side, and ischemia on the arterial side of 
the systemic circulation, great relief may be afforded by the abstrac- 
tion of from four to sixteen ounces of blood. In the apoplectiform 
variety of acute cerebral congestion, damage to the brain may be pre- 
vented by letting blood. The effect of the bleeding is to diminish the 
intra-cranial pressure, and thus relieve the strain on the cerebral ves- 
sels. In eclampsia, especially of the puerperal variety, accompanied 
with the evidences of cerebral congestion, great relief may be procured 
by the timely abstraction of blood. The quantity of blood to be taken 
will depend in part on the character of the subject and on the amount 
of congestion. 

The mechanical effect of the withdrawal of blood from the systemic 
circulation may be most advantageous in cases of sudden over-disten- 
tion of the right cavities of the heart. 

Pulmonary haemorrhage, when dependent on acute congestion of 



BLOODLETTING. 693 

the lungs, the general condition being one of plethora, may be promptly 
arrested by opening a vein in the arm. 

The pain of acute pleuritis, and acute peritonitis, can be quickly 
relieved by bloodletting. 

Although it is undeniable that the important results above men- 
tioned may be obtained from general bleeding, it is equally certain that 
as good results in most of the conditions may be had by other methods. 
Acute diseases make such serious demands on the vital resources of pa- 
tients, that the practitioner should seriously ponder the propriety of 
taking blood even in those cases to the relief of which it may seem to 
be adapted. Large bleedings, experience has abundantly shown, ren- 
der the convalescence from acute diseases tedious — for the patient 
has to make up the losses by venesection as well as the ravages of the 
disease. 

Bleeding by Cups and Leeches. — A large number of cups and 
leeches may produce the systemic effects of a general bleeding. But, 
as a rule, these applications are intended to withdraw blood from the 
affected part, and thus act in the manner entitled revulsive. The local 
irritation caused by cups and leeches must, through the agency of the 
nervous system, affect distant parts in the same manner as other coun- 
ter-irritants. 

Leeches are preferable to cups when the parts are very sensitive or 
inaccessible. The quantity of blood drawn can be more accurately 
measured when cups are used. The counter-irritant effects are much 
more pronounced from cups than from leeches. 

The amount of blood drawn by a leech will depend on its size, and 
the subsequent loss of blood, when the bleeding is encouraged, is de- 
termined by the vascularity of the part. As a general rule it may be 
stated that a leech will draw about four times its own weight — about 
one to two drachms. To obtain from any given patient four ounces 
of blood, one ounce of leeches must be applied. 

In acute gastric, enteric, and peritoneal inflammations, if the patient 
be plethoric, and there is decided sthenic reaction, leeches to the abdo- 
men are very serviceable. The number to be applied will always de- 
pend on the effect to be produced, employing the rules given above as 
the basis of the estimate. In typhlitis and perityphlitis, the author 
has seen such good results produced by leeches, that he holds they 
should never be omitted when the tenderness and fever begin. In 
acute hepatitis and congestion of the liver, and in acute dysentery, the 
best results are obtained by the application of leeches to the margin of 
the anus. Hemorrhoids that are swollen, painful, and irreducible 
without great suffering, are much relieved by the application of leeches 
directly to them. Pruritus of the anus, when due to engorgement of 
the portal circulation, and accompanied by heat of the anal region, 
may sometimes be cured by leeching the parts affected. 



694 TOPICAL REMEDIES. 

Acute desquamative nephritis, pyelitis, and congestion of the kid- 
neys, are ameliorated by the application of cups to the lumbar region. 

The following acute affections of the respiratory organs, when they 
occur in robust persons, and are accompanied by sthenic reaction, are 
favorably influenced in their course and duration by the application of 
cups or leeches — usually the former : pleuritis, pericarditis, acute ton- 
sillitis, acute laryngitis, and inflammatory croup. 

In acute inflammations of the uterus and its appendages, decisively 
good results are obtained by the application of leeches to the hypogas- 
tric region, to the iliac fossae, or to the uterus. 

Cupping the nape of the neck, or leeches to the mastoid process, are 
probably of service in acute congestion or inflammation of the intra- 
cranial structures ; but the indiscriminate employment of bloodletting 
in any case of cerebral disease is to be condemned. The correct rule 
may be formulated as follows : When bloodletting is indicated in in- 
tracranial maladies, venesection or arteriotomy (temporal artery) is to 
be preferred to the use of cups or leeches. 

Although good results are obtained by the local abstraction of blood 
in the diseases above mentioned, the author must express his convic- 
tion that the chief utility of cupping and leeching consists not in the 
blood withdrawn, but in the derivant and counter-irritant effect which 
they produce. Dry cups, a mustard-plaster, a turpentine-stupe, or 
other counter-irritant application, may render the painful process of 
cupping or leeching unnecessary. 

ESCHAROTICS. 

The substances belonging to this group are employed for the pur- 
pose of destroying the tissues to which they are applied. They differ 
in their mode of action, in the extent of the destruction which they 
effect, in their capacity for diffusion into the blood, and in the results 
which they severally accomplish. 

They are prescribed for the purpose of cauterizing poisoned wounds 
— syphilitic ulcers, snake-bites, the bites of rabid animals — for the re- 
moval of gangrenous parts, foul or exuberant granulations, and espe- 
cially for the destruction of malignant growths. When the diseased 
parts, to the destruction of which they are devoted, have been fully 
acted upon, the caustic action is ended ; poultices are applied to favor 
the entire separation of the sloughs, and a healthy surface is finally 
left to heal by granulations. 

The members of this group have, with one exception, been dis- 
cussed elsewhere : 

The mineral acids. 

The chloride and sulphate of zinc. 

Potassa fusa and potassa cum calce. 

Arsenious acid. 



DEMULCENTS. 695 

The acid nitrate of mercury. 
Bromine. 

Acidum Chromicum. — Chromic acid. In deep-red, needle-form 
crystals, deliquescent, and very soluble in water, forming an orange- 
red solution. 

Actions and Uses. — Chromic acid is an oxidizing caustic. When 
the action ceases, sesquioxide of chromium remains. It is slow in ac- 
tion, and not very painful, but it penetrates deeply and is remarkably 
destructive. Small animals, as mice and birds, are dissolved entirely, 
bones and all, by chromic acid. Owing to the fact that it penetrates 
deeply without much pain, care must be used in its application as a 
caustic, lest it injure parts which are not intended to be affected. 
When it is applied as a caustic, the surrounding tissues must be well 
protected. For the destruction of malignant growths, haemorrhoids, 
warts, etc., the acid should be made into a paste by the addition of 
sufficient water. The part to which it is applied first becomes yellow, 
then brownish, and ultimately black, and the eschar is detached in 
from twenty-four to forty-eight hours. 

A solution of chromic acid of the strength of one hundred grains to 
an ounce of distilled water is an efficient local application in syphilitic 
warts and vegetations, condylomata, lupus, sycosis, tinea tonsurans, 
etc. A still stronger solution (grs. xv — 3 j of hot water) has been in- 
jected into the uterine cavity with success in cases of uterine haemor- 
rhage and uterine catarrh (Wooster). 

Authorities referred to : 

Bcsch, Dr. E. Annuaire de TJierapeutique, vol. xsiv, p. 229. 

Heller, Dr. Ibidem, 1853, p. 283. 

Marshall, John. The Lancet, 1857, vol. i, p. 88. 

Wooster, Dr. The American Journal of the Medical Sciences, 1869, p. 367. 

EMOLLIENTS, DEMULCENTS, AND PROTECTIVE AGENTS. 

Glycerinum. — Glycerin. A colorless, inodorous, sirupy liquid, of a 
sweet taste, and having the specific gravity of 1*25. It is soluble in 
water and in alcohol, but not in ether. 

Glycerin- Ointment. — (Unofficial.) (Spermaceti, f ss ; white wax, 
3 j ; oil of almonds, f ij ; glycerin, § j — add the glycerin to the 
melted ingredients, and stir briskly till cold.) (Squire.) 

Glyceritum Vitelli. — Glyconin. An emulsion of glycerin and the 
yelk of eggs — 45 parts of the yelks and 55 parts of glycerin. (IT. S. P.) 

Glycerin- Cream. — (Glycerin, 1 ; soft soap, 1 ; cherry-laurel water, 
1.) (Squire.) 

Glycerin- Cream with Camphor. — (Glycerin, 2 ; camphor, 1 ; recti- 
fied spirit, 1.) (Squire.) 



696 TOPICAL REMEDIES. 

Glyceritum Amyli. — Glycerite of starch. (Starch, 10 parts ; gly- 
cerin, 90 parts.) (U. S. P.) 

Properties. — Exposed to the air, glycerin slowly absorbs moist- 
ure, but it does not evaporate, and it does not become rancid or under- 
go fermentation spontaneously. It is unctuous to the touch, and is 
obstinately sticky. Glycerin possesses remarkable solvent powers. 
One part of iodine and one of iodide of potassium dissolve in two parts 
of glycerin. Bromine, the iodide of sulphur, the chlorides of potas- 
sium and sodium, the alkalies, some of the alkaline earths, many of the 
neutral salts, the vegetable acids, especially tannic, most of the alka- 
loids (morphine, quinine, strychnine, veratrine, and atropine), and car- 
bolic acid, are soluble in glycerin. The fatty acids, cocoa-butter, 
camphor, chloroform, calomel, iodide of lead, and the resins, do not 
dissolve in glycerin. 

The antiseptic property of glycerin is decided. Vaccine lymph 
may be preserved unchanged almost indefinitely when stored up in 
pure glycerin ; and anatomical preparations, and specimens of natural 
history, are kept in preservative solutions consisting chiefly of this 
substance. Microscopical and pathological specimens are after a time 
softened and disintegrated by pure glycerin. 

Applied to the tissues of the body, glycerin, if pure, is perfectly 
bland and unirritating, as a rule, but in some subjects severe smarting 
is produced on contact of the purest glycerin with the mucous mem- 
brane. When it contains the fatty acids, oxalic or formic acids, it 
possesses very positive irritant qualities. It abstracts water from the 
tissues. 

Therapy. — No systemic effects are produced by the stomach ad- 
ministration of glycerin. It is an efficient remedy in acidity, pyrosis, 
and flatulence, in the dose of a drachm, before, with, or after meals. 

Glycerin has been proposed and used as a substitute for cod-liver 
oil, in the various cachectic states in which the latter is prescribed. It 
has been conclusively shown that it is inferior to cod-liver oil in every 
respect. As a vehicle for the administration of cod-liver oil, it is 
extremely serviceable (glyconin, a teaspoonful ; cod-liver oil, a tea- 
spoonful ; tincture of cinnamon, ten drops). 

Good results have been reported from the use of glycerin in dia- 
betes, but the data are as yet insufficient to enable a correct estimate of 
its real value to be made. The internal administration of glycerin 
has been resorted to for the removal of acne with success. It is 
said to destroy intestinal trichina, and may be given freely in trichi- 
nosis. 

The most important applications of glycerin, besides its numerous 
uses as a vehicle, are topical as an emollient. Applied to the affected 
mucous membrane by means of a camel's-hair pencil, pure glycerin 
affords great relief in acute coryza. Chronic follicular pharyngitis, 



PROTECTIVES. 697 

accompanied with profuse secretion, is generally improved by the same 
application, but the addition of tannic acid greatly enhances its cura- 
tive power in this affection. A solution of morphine in glycerin, ap- 
plied to the fauces with a brush, relieves the cough of phthisis. A 
better application in many respects is a mixture of glycerin, crystal- 
lized sugar, and whisky. This mixture, allowed to trickle slowly down 
the fauces, allays irritability and keeps the mucous membrane moist 
(glycerin, two parts ; whisky, one part ; crystallized sugar, a suffi- 
ciency). 

An enema of glycerin and infusion of flaxseed (one to four) allays 
the tenesmus in cases of acute dysentery. 

For chapped hands or face, glyconin is an excellent application. 
In seborrhoea, glycerin-cream gives good results. F 'or fissures of the 
nipple, Stille strongly recommends a " liniment made by adding one 
part of tincture of benzoin to six or eight of glycerin, and filtering 
the mixture." 

In pityriasis and in the papular eruptions, glycerin is serviceable, 
but, in general, it may be stated that its use in skin-diseases is disap- 
pointing, and that it is inferior as a local application to the usual oils 
and fats employed in this way. 

Glycerin has been used as a dressing for wounds and ulcerated 
surfaces, with more or less advantage. It is largely prescribed by 
gynaecologists as a topical application to erosions and ulcerations of 
the cervix uteri, and for the relief of vaginal leucorrhcea. 

The glycerite of starch (plasma) is an excellent vehicle for the ap- 
plication of astringents to the eye, and is much employed by ophthal- 
mologists for this purpose. Glycerin is used by otologists to soften 
cerumen, to entangle insects which have entered the ear, to diminish 
the secretion of pus, and to relieve the morbid state of the auditory 
canal in cases of otorrhcea. 

Collodium. — Collodion. Is a slightly opalescent liquid, of a sirupy 
consistence. By long standing it deposits a layer of fibrous matter, 
and becomes more transparent. This layer should be reincorporated, 
by agitation, before the collodion is used. When applied, it should 
form a colorless, transparent, flexible, and strongly contractile film. 

Collodium Flexile. — Flexible collodion. (Collodion, ninety-two 
parts ; Canada turpentine, five parts ; castor-oil, three parts.) 

Liquor Gutta-Perchae. — Solution of gutta-percha. (Gutta-percha, 
nine parts ; carbonate of lead, ten parts ; commercial chloroform, 
ninety-one parts.) 

Actions and Uses. — These solutions, when applied to the integu- 
ment, evaporate, leaving a transparent film or coating impervious to 
air and moisture. In drying, collodion contracts energetically, and 



698 TOPICAL REMEDIES. 

may indeed produce such a degree of constriction as to cause pain, 
and to render the part bloodless. Flexible collodion contains turpen- 
tine and castor-oil, which confer the property of flexibility, while they 
do not impair the impermeability of the film. The solution of gutta- 
percha has properties similar to flexible collodion. 

These solutions are employed to protect exposed parts from the 
contact of air, to secure primary union of incised wounds, to cause 
resolution of inflamed parts by mechanical pressure, etc. 

Some cases of chronic tubercular and squamous skin-diseases are 
much improved by coating them with the gutta-percha solution. Pre- 
vious to the application of the solution all scales should be removed. 
Excellent results have been obtained in herpes zoster by a thick coating 
of the flexible collodion or the gutta-percha solution : the pain is re- 
lieved, the vesicles aborted, and the duration of the disease shortened. 
As this is a self -limited disease, there must remain a suspicion of post 
hoc rather than propter hoc. Erysipelas, especially of the traumatic 
variety, is, at least, much relieved as regards the local symptoms by a 
thick coating of flexible collodion, but there is no evidence that it actu- 
ally shortens the duration of the disease. Burns to the first degree 
are greatly benefited by the same application ; it prevents contact of 
the air, and allays the irritation and pain. When, however, there is 
much exudation, or sloughing takes place, an impermeable coating 
adds to the distress. 

Collodion has been used without much success in small-pox, to hin- 
der the development of the pustules. Small boils, carbuncles, nmm, 
and even superficially placed aneurisms, may be so compressed as to 
arrest the local inflammation or to cause coagulation of the blood. 
Orchitis may be treated by a coating of collodion, instead of strapping. 
When the mechanical effects of the collodion are to be obtained, suc- 
cessive layers must be applied. 

Fissures of the nipples are best treated by flexible collodion or gutta- 
percha solution. The fissures are carefully wiped dry, well approxi- 
mated, and then thoroughly coated. Nipples that are retracted may 
be made more prominent by surrounding them, after being well drawn 
out, with a thick layer of collodion so placed that on contracting it will 
pucker the skin of the areola. 

Collodion has been used with success as a means of compression in 
umbilical hernia, spina-bifida, varicocele, etc. 

Chondrus. — Chondrus crispus. Irish moss. 

Cetraria. — Cetraria Islandica. Iceland moss. 
Decoctum Cetrarim. — Decoction of Iceland moss. 
Composition. — The principal constituent of chondrus is a mucilage, 
which, when dry, is horny, but swells up in water, forming a jelly. 



DEMULCENTS. 699 

Cetraria contains about seventy per cent of a starch (lichen-starch), a 
decoction of which gelatinizes on cooling. In addition to this starch 
cetraria contains a bitter principle (cetrarin), and a peculiar acid (lich- 
eno-stearic acid). 

These lichens are used only for the production of diets for the sick. 
They were formerly supposed to possess some peculiar virtues which 
rendered them serviceable to pulmonary invalids. As articles of food, 
they have a very low position as regards nutritive value. The decoc- 
tion of cetraria may be used as a stomachic tonic, containing as it does 
a bitter principle ; but it is only to be prescribed when the more effi- 
cient remedies are not well borne. 

Chondrus may be made into jelly or blanc mange, in the same way 
as gelatin is now prepared for this purpose. Neligan gives the fol- 
lowing recipe for the preparation of a jelly from chondrus : Chondrus, 
washed and macerated, thirty grains ; spring-water, a pint ; boil down 
to one half and strain with expression, and add to the strained liquor 
four ounces of white sugar, one ounce of gum-acacia, and thirty grains 
of powdered orris-root ; heat to dryness with a gentle temperature, 
stirring constantly so as to obtain a pulverulent mass, to which three 
ounces of arrow-root are to be added by trituration. A jelly is pre- 
pared with this powder by rubbing up a teaspoonful of it with a little 
cold water, and then pouring a cupful of boiling water on it. 

Acacia. — Gum-arabic. A gummy exudation from Acacia vera, and 
other species of Acacia. 

Mucilago Acacias. — Mucilage of gum-arabic. 

Syrupus Acaciai. — Sirup of gum-arabic. (Mucilage of acacia, 25 
parts ; sirup, 75 parts.) 

Tragacantha. — Tragacanth. The gummy exudation from Astraga- 
lus gummifer, and from other species of Astragalus. 
Mucilago Tragacanthoe. — Mucilage of tragacanth. 

Sassafras Medulla.— The pith of the stems of Sassafras officinale. 

Mucilago Sassafras Medullas. — Mucilage of sassafras-pith. 

Actions and Uses. — These preparations are used as demulcent 
drinks, in cases of acute inflammation of the stomach and intestines. 
They are supposed to make a protective coating on the inflamed part, 
and thus save it from further injury. They are especially indicated 
when irritating and corrosive substances have been swallowed. They 
are also frequently prescribed as diet-drinks in fevers and in acute in- 
flammations, in accordance with the supposition that they are not only 
soothing to the alimentary canal, but are, in a limited sense, foods. As 
nutrients these gums and mucilaginous substances rank very low, and 
can by no means take the place of such a food as milk. Furthermore, 



700 TOPICAL REMEDIES. 

they are exceedingly apt to undergo fermentation, and to produce flatu- 
lent colic and diarrhoea. 

Mucilaginous drinks are very frequently taken in catarrhal affec- 
tions of the bronchial tubes and of the kidneys, with the view to mod- 
ify the morbid process going on in these parts. It need hardly be 
stated that such a theory of the utility of demulcents is erroneous. 
Cough is modified by an influence which is probably reflex, when mu- 
cilages are applied to the fauces ; but in no other way can the mucous 
membrane of the air-passages be affected by such remedies taken into 
the stomach. As gums undergo digestion in the alimentary canal, it 
is obvious that they can not act as demulcents on any part of the 
urinary tract. 

The chief use of these remedies is in extemporaneous prescriptions, 
to hold insoluble medicines in suspension, and to cover the taste of dis- 
agreeable ingredients. 

Linum. — Flaxseed. The seed of Linum usitatissimum. 
Lini Farina. — Flaxseed-meal. 

Infusum Lini Composition. — Compound infusion of flaxseed. 
(Flaxseed, f ss ; licorice-root, 3 ij ; boiling water, Oj.) (Not official.) 

Ulmus. — Slippery-elm bark. The inner bark of Ulmus fulva. 
Mucilago TJlmi. — Mucilage of slippery-elm bark. 

Glycyrrhiza. — Licorice-root. The root of Glycyrrhiza glabra. 

Extr actum Glycyrrhiza}. — Extract of glycyrrhiza (licorice). 

Extractum Glycyrrhiza} Purum. — Pure extract of glycyrrhiza. 

Extr actum Glycyrrhiza} Fluidum. — Fluid extract of glycyrrhiza. 

Mistura Glycyrrhiza} Composita. — Compound licorice-mixture 
(brown mixture). A simple expectorant containing paregoric, wine of 
antimony, and spirits of nitrous ether. Dose, 3 j — ? ss. (Not official.) 

Actions and Uses. — The remedies of this group contain mucilagi- 
nous constituents on which their properties depend. They are fre- 
quently prescribed as protectives in gastro-intestinal disorders, and as 
expectorants in bronchial affections. 

Poultices. — Flaxseed-meal, powdered slippery-elm bark, and Indian 
or corn meal, are most frequently used for the preparation of poultices. 
Wheat-bread and milk are also occasionally employed for the same 
purpose. 

In the preparation of a poultice, the meal is slowly incorporated 
with hot water, until a mass of the proper consistency is made. The 
mixture itself should not be applied immediately to the part, for it 
dries and adheres with considerable tenacity. A piece of washed mus- 
lin of quadrangular shape, and of sufficient size, is selected ; the hot 



POULTICES. 701 

mass is spread on one end of the muslin, leaving a margin of one inch 
on three sides ; the long end of the muslin is then folded over the 
mass, and the free margins are stitched or pinned together. If the 
poultice is not frequently renewed, to prevent drying, some glycerin 
should be added to the surface which is to remain in contact with the 
tissues. Laudanum, or other narcotics, may be stirred in with the 
meal if the relief of pain be desirable. 

A yeast-poultice consists of brewers' yeast, to which sufficient flax- 
seed is added to give the proper consistence. 

A charcoal-poultice differs from an ordinary poultice in having 
powdered charcoal incorporated with the mass. In order that a char- 
coal-poultice shall have the proper consistence, the mass should be 
thin enough to take up a sufficient quantity of charcoal. 

Actions and Uses. — A poultice is a means of applying continu- 
ous heat with moisture, and of softening the tissues. An afflux of 
blood takes place to the part, the vessels dilate, the tissues, softened 
by the combined influence of heat and moisture, permit the easy diffu- 
sion of the fluids. If the process of inflammation has begun, or is in 
progress, the stasis is relieved, the tension of the inflamed part is less- 
ened, and resolution is thus favored ; or, if the stage of exudation is 
reached, the migration and multiplication of the white corpuscles are 
promoted, and the extrusion of purulent elements facilitated. The 
accumulation of blood in the neighborhood of the poultice seems to 
diminish the pressure elsewhere, and thus poultices of large size lower 
the arterial tension and lessen stasis in internal parts. Poultices re- 
lieve the pain of inflamed parts by relaxing the tissues, and thus re- 
moving pressure from the sensory nerve-filaments. The impression 
thus made on the peripheral nerve-endings is transmitted to the center 
and reflected over internal organs. It is within the range of every- 
body's personal experience that warm, moist applications relieve pain 
in internal and distant parts, which have no anatomical connection 
with the integument to which the applications are made. 

Poultices have, therefore, a local and a systemic effect. Their 
therapeutical uses are based on this conception of their physiological 
actions. They are prescribed to relieve the tension and to promote 
resolution or suppuration in boils, carbuncles, and other superficial in- 
flammations, to hasten the healing of irritable ulcers, to favor the sep- 
aration of gangrenous sloughs, etc. Foul-smelling wounds requiring 
the use of poultices are best treated with the yeast or charcoal poul- 
tice. 

Unquestionable benefit is derived from the application of hot 
poultices externally in acute faucial inflammations, in pneumonia, 
pleuritis, pericarditis, hepatitis, peritonitis, etc. 

The application of poultices sometimes degenerates into abuse. If 
too long continued, the skin becomes white, wrinkled, and sodden ; 



702 TOPICAL REMEDIES. 

small abscesses or boils form, and the vessels of the parts very slowly 
regain their tone. If kept too long in contact with wounds or ulcer- 
ated surfaces, the granulations become pale and flabby, and the heal- 
ing process is retarded. Applied indiscreetly to inflamed joints, they 
may promote suppuration, and thus permanently injure these struc- 
tures. If kept long in contact with a large extent of surface, they 
will lower the general tone and vigor of the system, depress the sys- 
temic circulation, exhaust the irritability of the vaso-motor nerves, 
and thus seriously embarrass the reparative process, if not wholly 
prevent repair. 



INDEX OF REMEDIES. 



Acacia 

Ac eta : 

Acetum Opii 

Lobeliae 

Sanguinariae 

Scillae 

Acida : 

Acidum Arseniosum 

Aceticum 

Benzoicum 

Boricum 

Carbolicum 

Chromicum 

Citricum 

Gallicum , 

Hydrocyanicum Dilutum 

Lacticum 

Hydrochloric urn 

Nitricum 

Nitromuriaticum 

Phosphoricam 

Salicylicum 

Sulphuricum 

Sulphurosum 

Tannicum 

Tartaricum 

Aconitine 

Aconitum Napellus and its preparations . 

Acupuncture ' 

Adeps 

Benzoinatus 

^Ether 

Ailanthus 

Air 



Compressed. 

Alcohol 

Ale 



Aliment 

Animal 

Vegetable 

in Inflammation 

in Digestive Disorders. 

Alimentation, Rectal 

Alkalies 

Alkaline Mineral Springs . . . 

Alnus Cerulata 

Aloes and its preparations . . 
Aloin 



, 516 

, 5S3 

. 312 

6T5 

144 
218 
353 
351 
322 
695 
218 
296 
5S5 

92 

94 

95 

95 

95 
335 

94 
220 
296 
218 
597 
59T 
6S0 
103 
103 
487 
611 

76 

79 
470 
4S5 
J, 49 

25 

34 

49 

51 

56 I 
187 
203 | 
29S J 
640 j 
641 



Alum 

Alumen 620, 



PAGB 

Alumen Exsiccatum 292 

Ammonia 211 

Ammoniacum and its preparations 460 

Ammoniae Yalerianus 461 

Ammonium and its preparations 210 

Ammonii Benzoas 210 

Amygdalae Oleum Expressuin 103 

Amyl Nitrite 591 

Anaesthesia 495 

Local 506 

Anaesthetics 495 

Animal Aliment 25 

Animal Diet 43 

Anemonin 607 

Anthelmintics 654 

Antimony and its preparations 283 

Antiseptics 317 

Antiseptic Oils 350 

Apiol 677 

Apomorphine 621 

Aqua 60 

Aquj: : 

Aqua Acidi Carbolici 322 

Ammonias 211 

Chlori 320 

Creosoti 323 

Aquapuncture 6S9 

Argentum and its preparations 260 

Aricine 564 

Arnica and its preparations 564 

Aromatic Bitters 161 

Arsenic and its preparations 144 

Arterial Transfusion 19 

Artificial Digestion 55 

Asafoetida and its preparations 453 

Aspidium .. .. 658 

Aspidospermine 616 

Atomization of Liquids 6 

Atropine 435 

Anrum and its preparations 258 

B 

Bantingism 40 

Baptisia 648 

Baptism 648 

Barium 215 

Barii Chloridum 215 

Baths 62 

Baunscheidtismus 689 

Beer 4S5 

Belladonna and its preparations 434 



704 



INDEX OF REMEDIES. 



PAGE 

Benzoates 354 

Benzoic Acid 353 

Benzoin 353 

Berberina 159, 165 

Berberine 159, 165 

Beverages 57 

Bismuth and its preparations 141 

Bitters, Aromatic 161 

Bitters, Simple 157 

Blisters 635 

Bloodletting 691 

Borocitrates 852 

Borotartrates 353 

Brandy 471 

Brayera and its preparations 659 

Bromine 321 

Beomldes : 

Ammonium 538 

Calcium 538 

Lithium 533 

Potassium 539 

Sodium 539 

Bro 673 

Broths, Animal, Formulae for 45 

Brown Mixture 700 

Brucine 391 

Buchu and its preparations 673 

Burgundy Pitch 684 

Buttermilk-Cure 47 

C 

Cacao Butter 103 

Cadmium and its preparations 287 

Caffeine and its preparations 57, 4G7 

Cajuputol 357 

Calabar Bean 573 

Calcii Hypophosphis 119 

Calcii Phosphas Praecipitatus 119 

Calcium and its preparations 97 

Calomel 244 

Calumba and its preparations 15S 

Calx 197 

Chlorata 320 

Cambogia 648 

Camphor and its preparations 454 

Camphor Monobromate 5?8, 455 

Cannabis Americana 463 

Indica. 463 

Canquoin's Paste 2S2 

Cantharidal Collodion 635 

Cantharidin 630 

Cantharis and its preparations 630 

Capsicum and its preparations 670 

Carbolic Acid 322 

Carica Papaya 89 

Carlsbad . . . *. 203 

Carota 674 

Carophyllus 356 

Cascarilla 161 

Castanea Vesca 299 

Castor-oil 631 

Catechu and its preparations 296 

Cathartics 629 

Centaury Americana 158 



PAGE 

Cekata : 

Ceratum Cantharidis 685 

Extracti Cantharidis 685 

Plumbi Subacetatis 272 

Zinci Carbonatis 278 

Cerebral Excitants 454 

Cerium and its preparations 288 

Cetraria 698 

Cetrarin 698 

Chalk 197 

Chalybeate Mineral Springs 139 

Champagne 4S0 

Charts : 

Charta Cantharidis 685 

Sinapis 683 

Chenopodium and its preparations 657 

Chimaphila and its preparations 678 

Chinoidine 169 

Chinoline 349 

Chloral Hydrate 509 

Croton 515 

Chlorinated Lime 320 

Chlorine 320 

Chlorodyne 494 

Chloroform 491 

Chondrus 698 

Chromic Acid 695 

Chrysophanic Acid 638 

Cimicifusra and its preparations 432 

Cimicifugine 432 

Cinchona and its preparations 167 

Cinchonine 168 

Citric Acid 218 

Citrine Ointment 246 

Coca 466 

Cocoa 57 

Cocculus 404 

Codeine 518 

Cod-liver Oil 103 

Coffee 57 

Colchicine 304 

Colchicum and its preparations 304 

Collodion 697 

Collodium cum Cantharide 685 

Collodium Flexile 693 

Stypticum 296 

Colocynth and its preparations 644 

CONFECTIONES : 

Confectio Rosae , 298 

Opii 516 

Sennaa 637 

Conine 550 

Conium and its preparations 550 

Convallaria 429 

Convallarin 429 

Copaiba and its preparations 666 

Copper, preparations of 268 

in Metallotherapy 289 

Coptis 158 

Cornus Florida 158 

Corrosive Sublimate 245 

Counter-irritants 683 

Creosote 322 

Creta 197 

Croton-Chloral 515 



INDEX OF REMEDIES. 



ros 



PAGE 

Croton-oil 649 

Cubeb and its preparations 663 

Cuca 466 

Cupri Sulphas 619, 263 

Cuprum and its preparations 268 

Curara 555 

Curarine 555 

Cyanide of Potassium 589 

D 

Dandelion , 674 

Daturia ; 446 

Decocta : 

Decoctum Cetrarias 698 

Chimaphilas 673 

— — Cinchonas Flavae 167 

" Eubras 167 

Corn us Floridse 158 

Hasmatoxyli 297 

Quercus Albse . 297 

Sarsaparillas Compositum 307 

Uvas Ursi 673 

Demulcents 695 

Denutrition 3.8 

Diet-Drinks, formulas for 50 

Diet, dry 41 

milk 44 

Diet, plans of 38 

Digestion- Ferments 87 

Digitaline 422 

Digitalis and its preparations 422 

Douche 64 

Nasal 5 

Dover's Powder 516 

Dry Diet 41 

Duboisia 452 

Duboisine 452 

E 

Effervescing Powders 195 

Elaterin 651 

Elaterium 651 

Electricity 359 

Electrolysis 383 

Electro-Diagnosis 376 

Physiology 372 

Therapy 379 

Emetine. . 619 

Emetics 619 

Emollients 695 

EMPLA8TBA. : 

Emplastrum Ammoniaci 460 

Ammoniaci cum Hydrargyro 244 

Antimonii 283 

Arnicas 564 

Asafcetida 458 

Belladonnas 434 

Ferri 123 

Hydrargyri 244 

Opii. 516 

Picis Burgundicas 684 

Picis Canadensis 684 

Picis cum Cantharide 634 

Plumbi 272 

Ems 205 

45 



PAGE 

Endermatic Method 4 

Enemata 652 

Forms of 653 

Nutrient 55 

Enepidermatic Method . , 3 

Epidermatic Method 4 

Epispastics 685 

Epsom Salts 633 

Ergot and its preparations 408 

Ergotin 408 

Ergotinine 409 

Erigeron 672 

Erythroxylon 466 

Escharotics 694 

Eserine 574 

Ether 487 

Ether Aceticus 488 

Ethyl Bromide 488, 504 

Iodide 238 

Eucalyptol 162 

Eucalyptus and its preparations 162 

Euonymus 647 

Euonynim 647 

Evacuants 619 

Extract a : 

Extractum Aconiti 597 

Belladonnas 434 

Belladonnas Alcoholicum 434 

Cannabis Americans 463 

" Indices 463 

Cinchonas 168 

Colchici Aceticum 304 

Colocynthidis 644 

Colocynthidis Compositum 644 

Conii Alcoholicum , 550 

Digitalis 421 

Eucalypti 162 

Gentianas 157 

Glycyrrhizas. 700 

Hasmatoxyli 297 

Hyoscyami Alcoholicum 447 

Krameriae 297 

Nucis Yomicas 391 

Opii 516 

Physostigmatis 574 

Podophylli 645 

Quassias 157 

Ehei 638 

Stramonii 446 

Taraxaci 674 

Exteacta Flttida : 

Extractum Aconiti Fluidum 597 

Ailanthi Fluidum. 611 

Belladonnas Fluidum 434 

Buchu Fluidum 673 

Calumbas Fluidum 158 

Chimaphilas Fluidum 673 

Cimicifuga Fluidum 432 

Cinchonas Fluidum 168 

Cocas Fluidum 466 

Colchici Eadicis Fluidum 304 

" Seminis Fluidum 304 

Conii Fluidum 550 

Cornus Floridas Fluidum 158 

Cubebas Fluidum 663 



706 



INDEX OF REMEDIES. 



PAGE 

Extractum Digitalis Fluidum 421 

Ergotae Fluidum 408 

Erythroxylon Fluidum 466 

Eucalypti Fluidum 162 

Gelsemii Fluidum 560 

Gentianae Fluidum 157 

Grindeliae Fluidum 608 

Guaranas Fluidum 469 

Hydrastis Fluidum 165 

Hyoscyami Fluidum 447 

Ipecacuanha? Fluidum 623 

Jaborandi Fluidum 567 

Krameriae Fluidum 297 

Lupulinae Fluidum 537 

Nucis Vomicae Fluidum 391 

Pareirae Fluidum 678 

Phytolacca? Fluidum 610 

Pilocarpi Fluidum 567 

Pruni Virginianae Fluidum 161 

Quassiae Fluidum 157 

Khei Fluidum 638 

Sabinae Fluidum 679 

Sanguinariae Fluidum 312 

Sarsaparillae Fluidum 307 

" Compositum Fluidum 307 

Sennae Fluidum 633 

Serpentariae Fluidum 161 

Spigelias Fluidum 657 

Stillingiae Fluidum 310 

Taraxaci Fluidum 674 

Uva Ursi Fluidum 673 

Ustilaginis Maidis Fluidum 420 

Valerianae Fluidum 461 

Veratri Viridis Fluidum 602 

Xanthoxyli Fluidum 315 

F 

Faradism 369 

Faradic Electricity 869 

Fats and Oils 103 

Ferments 87 

Ferrum and its preparations 123 

Dialysatum 125 

Filix Mas 658 

Firing 684 

Flax-seed 695 

Flexible Collodion 693 

Fluid Extracts (see "Extracta Fluida"). 

Fowler's Solution 144 

Friedrichshall 198 

Fumigations ? 

G 

Galla 296 

Gallic Acid 296 

Galls 296 

Galvanism 362 

Galvano-caustic 389 

— — Therapy 381 

Gamboge 648 

Gargles 279 

Gaultheria 356 

Gelsemine 560 

Gelaemium and its preparations 559 



PAGE 

Gentian 157 

Catesby's 157 

Geranium 297 

Glycerin 695 

Gltceeita : 

Glyceritum Acidi Carbolici 517 

Amyli 695 

Vitelli 695 

Glycyrrhiza 700 

Gold and its preparations 258 

Gold in Metallotherapy 289 

Goldthread 158 

Goulard's Extract 272 

Ointment 272 

Granatum 658 

Grape-Cure 42 

Grindelia 608 

Guarana ' 469 

Guaiacum and its preparations 309 

H 

Hamamelis Virginica 298 

Haematoxylon and its preparations 297 

Heat 73 

Hemlock 550 

Heuchera 298 

Hip-Bath 64 

Homburg 207 

Homotropine 445 

Hope's Mixture 96 

Hops 537 

Humulus and its preparations 537 

Hydragogue Cathartics 648 

Hydrargyrum and its preparations 244 

Hydrastine 165 

Hydrastis and its preparations 165 

Hydrate of Chloral 509 

Hydrochloric Acid 94 

Hydrocyanic Acid 585 

Hydroquinone 349 

Hydrotherapy 60 

Hyoscine • • 451 

Hyoscyamine 447 

Hyoscyamus and its preparations 447 

Hypodermatic Method 11 

Remedies 13 

I 
Infttsa: 

Infusum Buchu 673 

Calumbae 158 

Capsici 670 

Cascarillae 161 

Catechu Compositum 297 

Cinchonae Flavae 167 

" Rubrse 167 

Cocae 466 

Digitalis ' 421 

Gentianae Compositum 157 

Humuli 537 

Jaborandi 567 

Juniperi 671 

Lini Compositum 695 

Pareirae 678 



INDEX OF REMEDIES. 



707 



PAGE 

Infusum Pilocarpi 567 

Pruni Virginianae 161 

Quassiae 157 

Ehei 638 

Sennae Compositum 637 

Serpentariae 161 

Spigeliae 657 

Tabaci 579 

Taraxaci 674 

Valerianae 461 

Igasuric Acid 391 

Ignatia 404 

Infant- Feeding 47 

Ingluvin 87 

Inhalations 6 

Injections— Intravenous 15 

Insufflation 4 

Inunction Method 106, 254 

Iodides, 227 

Iodine and its preparations 227 

Iodoform 227, 239 

Ipecacuanha and its preparations 623 

Iris Versicolor 647 

Iridin 647 

Iron and its preparations 123 

J 

Jaborandi and its preparations 567 

Jalap and its preparations 643 

Jervia 603 

Juniper and its preparations 671 

K 

Kairine 349 

Kairoline 349 

Kameela 659 

Kino and its preparations 297 

Kissingen 207 

Koumiss 32, 46 

Kousso 659 

Koussine 659 

Krameria and its preparations 397 

L 

Lactic Acid 92 

Lactucarium 538 

Lactucarine 538 

Lard 103 

Laxatives 629 

Lead and its preparations 272 

Leptandra 646 

Leptandrine 646 

Licorice 700 

Lime and its preparations 197 

Lini Farina 695 

Linum and its preparations 695 

LlNIMENTA I 

Linimentum Aconiti 597 

Ammoniae 211, 684 

Camphorre 455, 685 

Cantharidis 684 

Chloroformi 684 

Saponis 455, 685 

Terebinthinae 660, 685 



PAGE 

Liquoees : 

Liquor Ammoniae Acetatis 211 

Arsenici Chloridi 144 

Arsenici et Hydrargyri Iodidi 144 

Ferri Citratis 124 

Caicis 197 

Caicis Saccharatus 198 

Ferri Chloridi 124 

" Nitratis 124 

" Subsulphatis... 123 

" Tersulphatis 124 

Gutta-Perchae 698 

Hydrargyri Nitratis 246 

Iodi Compositus 227 

Magnesii Citratis 633 

Morphinae Sulphatis 518 

" Bimeconatis 518 

Pancreaticus 88 

Plumbi Subacetatis 272 

Potassae 188 

Potassii Arsenitis 144 

" Citratis 188 

Sodae 195 

Sodae Chlorinatae 320 

Sodii Arseniatis 144 

Zinci Chloridi 278 

Lithium and its preparations 199 

Lobelia and its preparations 583 

Lobeline 583 

Lupulin 537 

M 

Malt Liquors 396 

Magnesia and its preparations 630 

Magnesii Carbonas 630 

Citras 633 

Sulphas 633 

Magnetism 361 

Magneto-Therapy 381 

Manganum and its preparations 136 

Manna 629 

Massage , 83 

Mel Eosae 298 

Mercury and its preparations 244 

Mercurial Inunction 254 

Fumigation 254 

Purgatives 636 

Metallotherapy. 289 

Methylene Bichloride 505 

Milk as a Beverage 59 

Milk-Diet.. 30, 44 

M18TPE.E : 

Mistura Ammoniaci 460 

Asafcetidae 458 

Cretae 198 

Ferri Aromatici 125 

Ferri Composita 123 

" Laxans 125 

' Gentianae Alkalina 157 

" et Sennae 157 

Glycyrrhizae Composita 700, 283 

MonsePs Solution 123 

Morphine and its Salts 518 

Muoilagines : 

Mucilago Acaciae 699 



708 



INDEX OF REMEDIES. 



PAGE 

Mucilago Sassafras Medullse 699 

Tragacanthae 699 

Ulmi 700 

Mucuna 654 

Muriatic Acid. 94 

Muscarine 612 

Mustard 683 

Myrica Cerifica 293 

Myrtol 357 

N 

Napelline , 597 

Narceine 525, 517 

Narcotine 518 

Nasal Douche 5 

Nicotine 579 

Nicotianine 579 

Nitre 1 88 

Nitric Acid 95 

Nitrite of Amyl 591 

Nitro-glycerin 594 

Nitro-Hydrochloric Acid 94 

Nitrous Oxide 507 

Nutrient Enemata 55 

Nux Vomica and its preparations 391 

Nymphaea Odorata 299 

O 

Oils and Fats 103 

Olea Destillata : 

Oleum Oajuputi 356 

Caryophylli 356 

Chenopodii 657 

Copaibae 666 

Cubebae 668 

Erigerontis Canadensis 672 

Gaultheriae 356 

Juniperi 671 

Kicini. 631 

Butae 679 

Sabinae 679 

Tabaci 579 

Terebinthinae 660 

Thymi 356 

Oleate of Mercury 245 

Oleatum Hydrargyri 245 

Yeratrinae 602 

Oleoeesin^e : 

Oleoresina Capsici 670 

Cubebae 668 

Aspidii 658 

Lupulinae. 537 

Piperis.. 669 

Oleum Amygdala? Expressum 103 

Gossypii Seminis 103 

Lini 103 

Morrbuae 103 

Olivae 103 

Phospboratum 110 

Pacini 631 

Tbeobromae 103 

Tbymi 356 

Tiglii 649 

Valerianae 461 



page 

Opium and its preparations 516 

Oxygen 318 

P 

Pancreatin 88 

Papa'ine 89 

Paraldehyde 486 

Paregoric 517 

Pareira 673 

Parilline 808 

Parrish's Chemical Food 119 

Parsley 677 

Paverine 518 

Pelleterine 658 

Pepo 659 

Pepsin 87 

Peptones 88 

Petroselinum 677 

Perkins's Tractors 289 

Phenoresorcin 349 

Phosphates and Phosphites 119 

Phosphoric Acid 95 

Phosphorus and its preparations 110 

Physostigma and its preparations 573 

Phytolacca 610 

Picrotoxin 405 

Pilocarpine Hydrochlorate ... 567 

Pilocarpus 567 

Pilule : 
Pilulae Aloes 640 

" et Asafcetidae 458,640 

" et Mastiches 640 

" et Myrrhae 640 

Antimonii Composite 246 

Asafoetidse 458 

Cathartic© Compositae C44 

Copaibae 666 

Ferri Carbonatis (Massa) 123 

" Compositae 123 

" Iodidi 124 

Galbani Compositae 458 

Hydrargyri (Massa) 245 

Opii 516 

Phosphori 110 

Quininae Sulphatis 168 

Ehei 638 

" Compositae 63S 

Scillae Compositae 675 

ttaponis Compositae 517 

Pink-root 657 

Piper 669 

Piperine 669 

Pipsissewa and its preparations 678 

Plumbism 273 

Plumbum and its preparations 272 

Podophyllum and its preparations 645 

Polygonum Hydropiperoides 678 

Pomegranate 658 

Porter 485 

Potassii Cyanidum 589 

Permanganas 136 

et Sodii Tartras 188 

Potassium and its preparations 187 

Poultices 700 

Propylamine 565 



INDEX OF REMEDIES. 



709 



PAGE 

Primus Virginiana 161 

Prussic Acid 585 

Pulsatilla 607 

PULVEBES : 

Pulveres Effervescentes 195 

Pulvis Aloes et Canellae 641 

Pulvis Effervescens Compositus 196 

Glycyrrhizse Compositus 630 

Ipecacuanha? et Opii 623, 516 

Jalapae Compositus 643 

Morphinae Compositus 578 

Pulverization 6 

Pumpkin-seed 659 

Purgatives 629 

Pyrocatechin 349 

Q 

Quassia and its preparations 157 

Quercus and its preparations 297 

Quinina and its Salts 168 

for Hypodermatic Use 184 

Quebracho '. 616 

Quebrachine 616 

R 

RaspaiPs Eau Sedatif 211 

Reichenhall 208 

Eesin^e : 

Eesina Jalapae 643 

Guaiaci 309 

Podophylli 645 

Scammonii 644 

Eesorcin 346 

Ehatany and its preparations 297 

Rheum and its preparations 688 

Rhubarb 638 

Rosa Gallica and its preparations 298 

Rottlera 659 

Rubefacients 683 

Rubus .298 

Rue 678 

Russian Baths 62 

S 

Sabbatia 158 

Sabina 679 

Sal-Ammoniac 210 

Salicin 334 

Salicylate of Soda 335 

Salicylic Acid 335 

Salix 334 

Sanguinaria and its preparations 312 

Sanguinarine 312 

Sacguinarinic Acid 312 

Saline Mineral- Waters 206 

Saline Purgatives 633 

Santonica 655 

Santonin 655 

Saratoga Springs 207 

Sarsaparilla and its preparations 307 

Sassafras Medulla 699 

Savine 679 

Scammony and its preparations 644 

Scilla and its preparations 675 

Scoparius 673 

Seidlitz Powders 195 



PAGE 

Senna and its preparations 637 

Serpentaria and its preparations 161 

Sevum 103 

Silver and its preparations 260 

Sinapis Alba 621, 683 

Nigra 621, 6S3 

Sitz-Bath 64 

Smilacine A 308 

Sodii Hypophosphis ; 119 

Phosphas 119 

Pyrophosphas 119 

Salicylas 335 

Sulphas 637 

Sodium and its preparations 195 

Spigelia and its preparations 657 

Spirittts : 

Spiritus iEtheris Compositus 48T 

^Etheris Nitrosi 487 

Ammonias 211 

Ammonia? Aromaticus 211 

Camphorae " 455 

Chloroformi 491 

Frumenti 471 

Juniper Compositus 671 

Vini Gallic! 471 

Squill 675 

Statice Limonium 298 

Static Electricity 359, 390 

Steam-Bath 69 

Stillingia and its preparations 310 

Stillingin 310 

Stramonium and its preparations 446 

Strychnine and its Salts 392 

Styptic Colloid 296 

Sulphides 222 

Sulphocarbolates 332 

Sulphur and its preparations 630 

Sulphuric Acid 94 

Sulphurous Acid 220 

Sulphurous Mineral-Waters 224 

Suppositoeia : 

Suppositoria Acidi Tannici 296 

Sykttpi : 

Syrupus Acaciae 699 

Calcis 198 

Calcii Lacto-phosphatis 119 

Eerri Iodidi 124 

" et Manganii Iodidi 136 

" " Phosphatis 125 

Hypophosphitum 119 

" cum Ferro 119 

Ipecacuanha? 623 

Lactucarii 538 

Manganii Iodidum 136 

Pruni Virginianse 161 

Rhei 639 

" Aromaticus 639 

Rubi 298 

Sarsaparillae Compositus 807 

Scillae 675 

" Compositus 283, 675 



Tabacum and its preparations 579 

Tannic Acid 296 



710 



INDEX OF EEMEDIES. 



PAGE 

Taraxacum 674 

Tartar Emetic . . . 283 

Tartaric Acid 218 

Tea 57 

Terebinthina 660 

Thebaine 519 

Thymol 356 

TnsrcTTTE.E : 

Tinctura Aconiti Eadicis 597 

Aloes 640 

" et Myrrhae 640 

Arnicae 564 

Asafcetidae 458 

Belladomiae 434 

Benzoini 853 

" Composita 853 

Calumbse 158 

Cannabis Indicee 463 

Cantharidis 680 

Capsici 670 

Catechu 297 

Cimicifugae 432 

Cinchonae 168 

" Composita 168 

Colchici 804 

Cubebae 668 

Digitalis 421 

Eucalypti 162 

Eerri Acetatis ^theria 124 

" Chloridi 123 

Gallae 296 

Gentianae Compositae 157 

Guaiaci 309 

" Ammoniata 309 

Humuli 537 

Hydrastis 165 

Hyoscyami 447 

Ignatiae 404 

Iodi 227 

Ipecacuanhae et Opii 623 

Jaborandi 567 

Jalapae 643 

Kino 297 

Krameriae 297 

Lobeliae 583 

Lupulinae 537 

Nucis Vomicae 391 

Opii 516 

" Acetata 516 

" Camphorata 516 

" Deodorata 516 

Phosphori 110 

" ^Etherialis 110 

Physostigmatis 574 

Phytolaccae 610 

Pilocarpi 567 

Pulsatillae 607 

Quassiae 157 

Ehei 638 

" Aromaticus 689 

Sanguinariae 312 

Scillae 675 

Serpentariee 161 

Stramonii 446 

Valerianae 461 



PAGE 

Tinctura Valerianae Ammoniata 461 

Veratri Viridis 602 

Tobacco 579 

Topical Eemedies 683 

Transfusion 16 

of Milk 20 

Peritoneal 21 

Tragacanth 699 

Trimethylamine 565 

Trochisci : 

Trochisci Acidi Tannici 296 

Cubebfe 668 

Catechu 297 

Ferri Subcarbonatis 123 

Ipecacuanhae 623 

Morphinae et Ipecacuanhae 518, 623 

Potassii Chloratis 188 

Santonini 656 

Tully's Powder 518 

Turpentine 660 

Turpeth Mineral 245 



Ulmus 700 

Unguenta : 

Unguentum Acidi Carbolici 322 

Acidi Tannici 296 

Antimonii 283 

Belladonnae 434 

Benzoini 353 

Gallae 296 

Hydrargyri 245 

" Ammoniata 246 

" Iodidi Eubri 246 

" Nitratis 246 

41 " Eubri 247 

" OxidiFlavi ..245 

" " Eubri 245 

Iodi 227 

Iodoformi 227 

Potassii 227 

Plumbi Carbonatis 272 

" Iodidi 273 

Stramonii 446 

Tabaci 579 

Veratrinae 602 

Zinci Oxidi 278 

Urino-Genital Eemedies 660 

Ustilago Maidis 420 

UvaUrsi 673 



Valerian and its preparations 461 

Vapor-Bath , 74 

Vegetable Acids 218 

Vegetable Diet 84, 42 

Venesection 691 

Veratrine 602 

Veratroidia 603 

Veratrum Viride 602 

Vichy 203 

Vienna Paste 201 

Villate's Solution 281 

Vinegar 218 



INDEX OF REMEDIES. 



711 



PAGE 

Vina : 

Yinum Aloes 640 

Antimonii 283 

Colcbici Radicis 304 

" Seminis 304 

Ergotae 403 

Ferri Amarum 125 

" Citratis 125 

Ipecacuanbae 623 

Opii 516 

Rhei 639 

Tabaci 579 

Yinum 480 

Album 480 

" Fortius 480 

W 

Water 60 



PAGE 

Wet Pack 63 

Wbey-Cure 46 

Wbisky 471 

Wine 430 

Woorara 555 

Worm-seed 657 

X 

Xantboxylum 315 

Xantboxylin 315 

T 
Yellow Eoot 165 

Z 

Zinc and its preparations 278 

Zinci Pbospbidum 110 

Zinci Sulpbas 278, 620 



CLINICAL INDEX 



Abdominal Plethora : 
Aliment, water- free food, 42; laxative diet, 52; 

grape-cure, 42. 
Cathartics, saline, 633; resin-bearing, 637; and 

hydragogue purgatives, 648. 
Saline Mineral Waters, 205, especially Saratoga, 

Vichy, and the purgative saline, generally. 
Abortion : 
Aurum, 259. The chloride, to avert the tendency 

to habitual abortion. 
Opium, 531. To check uterine action, and Ergot, 

415, to restrain haemorrhage. 
Abortifacients, ergot, savine, rue, aloes, picrotox- 

ine, apiol, pilocarpus, colocynth, the hydragogue 

cathartics, etc., all dangerous to life when used 

in sufficient quantity to produce abortion. 



Belladonna plaster, 445. Emplastrwm Ammo- 
niaci cum hydrargyro, 460. Leeches, 693. 
Nitrate of Silver in nitrous ether applied over 
inflamed area and adjacent region to abort in- 
flammation, 265. Tincture of Iodine as a coun- 
ter-irritant, and as an antiseptic injected into 
the sac of an abscess, 237. Carbolic Acid, 
330, Salicylic Acid, 345, Resorcin, 349, and 
Boracic Acid, 352, for antiseptic dressing. 
Sulphides, 223, gr. i every few hours to abort 
abscess, or hasten the formation and extrusion 
of pus. Potass, permangan., 13S, as a de- 
odorant. 

Acidity : 
Mineral Acids, 97, before meals. Acid fermen- 
tation, with vomiting of pasty matter, sulphu- 
rous acid, 221. During meals an acid wine 
(Rhine). For immediate relief, alkalies after 
meals, 193. The frequent use of alkalies en- 
hances the mischief. Lime-water, 199. Car- 
bonate of Ammonia, 213, Alkaline Mineral- 
waters, 205. Tannic Acid, 299, in pill-form— 
VI j glycerin to gr. iv of tannin. Carbolic 
Acid, 326, stops fermentation and eructations. 
Bismuth, 143, with carbolic acid, gives excel- 
lent results. The purified black Oxide of Man- 
ganese, 137, and Oxide of Silver, 263, are ser- 
viceable, acting as local sedatives and preventing 
acid fermentation. Acetate of Lead, 275, Kino, 
300, and JVux Vomica Tincture, 397, act in the 
same, and rather remove the causes than affect 
the acidity directly. 

Acne : 
Phosphorus, 118. Even more effective and safer 



are the hypophosphites and phosphates. Ar- 
senic, 153; sometimes beneficial, but on the 
whole disappointing. Bismuth, 144, is an ex- 
cellent topical application when there are heat 
and redness. SubUmed Sulphur, 630, applied 
as a powder to the eruption is one of the best 
applications. Alkaline lotions, when the skin 
is greasy and the sebaceous follicles full, are 
useless; for example, liquor potassce in rose- 
water, 200. Lotions of corrosive sublimate, 
256. Glycerin, 697, internally. 

Adynamia : 
Alcohol, 478, is serviceable when it improves the 
appetite and digestion, when the tongue be- 
comes moist, and when delirium subsides under 
its use. Brandy is the best form when bowels 
are relaxed ; whisky when there is constipation. 
A wine of good body and high bouquet in the 
weakness of sedentary occupations. Aliment, 
53, beef, milk, cod-liver oil. Bitters, especially 
calumba, 160, and hydrastine, 166, as a substi- 
tute for quinine. Eucalyptus, 163, for malarial 
adynamia, but especially the alkaloids of cin- 
chona, notably quinine, 177, gr. ij — gr. v, ter 
in die. Iron, 130, to stimulate digestion and 
promote blood formation, with manganese. 
Chalybeate springs, 139. JVux Vomica Tinc- 
ture, 297, with capsicum in the case of inebri- 
ates. 
Coca, 467, prevents waste, and favors constructive 
metamorphosis. 

After-pains: 

Chloral, 514, one of the most efficient remedies, 
but considerable doses necessary. Camphor, 
457, effective, with or without morphine. Gel- 
semium, 563, also stops after-pains ; but, as 
large doses are necessary, safer remedies are 
preferable. Morphine and atropine, 535, sub- 
cutaneously or by the stomach, very certain to 
relieve, 543. Cimicifuga, 433, affords some re- 
lief. 

Albuminuria : 
Milk cure, 46, especially buttermilk, 47. Iron, 
133, and the purgative chalybeate waters, 139, 
for the anaemia. Arsenic, 153, for the intersti- 
tial changes in kidneys. Alkaline diuretics, 
195. Gallic acid, 301, especially Aitken's for- 
mula to restrain loss of albumen. Oxygen, 319. 
Gold, chloride, in chronic form, 259. Nitro- 
glycerin, 596. Pilocarpus, 571. Digitalis, 
428. 






CLINICAL INDEX. 



713 



Alcoholism: 
Bromides, 543, especially for the "horrors," in 3 - 
doses. Capsicum, 671, for its stomachic tonic 
and hypnotic qualities. Chloral, 513, very effi- 
cient in the acute form, but caution is required 
in old drunkards. Opium, 531, but cautiously. 
Zinc Oxide, 281, for the chronic state, with 
piperine or capsicum. Cinchona, 176, 183, es- 
pecially the C. Eubra fluid extract. Lupulin, 
537, fluid extract with capsicum ; good substi- 
tute for alcoholic stimulants. Picrotoxin, 407, 
for the muscular tremors. Nux Vomica, 39S, 
nerve and stomachic tonic. 

Amaubosts : 
Strychnine, 400, hypodermically, curative in 
functional disease caused by tobacco, alcoholic 
excess, etc. 

Amenobbhosa : 
Aconite, 601, for sudden suppression due to cold. 
Aloes, 642, when due to anaemia and torpor. 
Iron, 132, when anaemia is the cause, may be 
given with nerve stimulants, as nux vomica. 
Chalybeate Waters, 139. Apiol, 677, and Hy- 
dropiper, 678, when there is functional inactiv- 
ity of ovaries, preceded by a chalybeate course, 
by aloes, apiol being given just before the period 
for several days. Arsenic, 154, as a reconstit- 
uent, combined with iron. Aurum, 259, a 
stimulant of the menstrual function. Asafozti- 
da, 459, for the nervous disturbance and as 
an ovarian stimulant. Electricity , 3S7, faradic 
and static ; very efficient to start the flow when 
suitable preparation has been made. Ergot, 
416, is useful when plethora exists. Rue, 679, 
and Savin, 6S0, are active stimulants, to be 
given with great caution. Pulsatilla, 608, used 
under the same circumstances as aconite in 
sudden arrest of flow. 

Anaemia : 

Compressed Air, 81. Oxygen, 319. Iron, 130. 
Arsenic, 151, an adjunct of iron, or when the 
latter can not be borne. Pepsin, 90, and Pan- 
creatin, 92, to aid the primary assimilation. 
Lacto-phosphate of lime, 121, a material need- 
ed in the anaemia of lactation and of suppura- 
tion. Manganese, 137, of use when associated 
with iron. Galvanization, central, and gen- 
eral faradization, 386, to stimulate the functions 
of organic life. Wines, 483, especially the red 
wines with good body. 

Anaesthetics : 
Eules for administration, 498. Morphine, subcu- 
taneously by the method of Bernard, 499, facili- 
tates the inhalation, lessens the dangers, and 
prolongs the anaesthetic stage with a less quan- 
tity of the anaesthetic. Whisky, 499, adminis- 
tered before inhalation, sustains the heart and 
prolongs the narcosis. Means of restoration, 
500, depressing head, drawing out tongue, arti- 
ficial respiration, inhalation of ammonia, or in- 
travenous injection of the same, faradization of 
chest-muscles, electro-puncture of the heart, etc. 

Anesthesia : 
Magnetism, 3S1, and Metallotherapy, 289, for 
the hysterical state, and for other forms the 
electric brush, 3S6, and strychnine, 402. 



Aneubism : 

Aliment, 41, 46, denutrition cure. TufnelTs plan, 
41. Barium Chloride, 217, acts by raising the 
arterial tension, and has been used successfully. 
Iodides, 231, in full doses, relieve pain, and 
promote coagulation of blood in the sac. Ace- 
tate of Lead, 276, depresses the heart and 
raises the arterial tension. Veratrum Viride, 
605, 6lows the circulation, and thus facilitates 
coagulation in the sac. Aconite and other ar- 
terial sedatives act similarly; but their action 
must be aided by a proper diet and absolute 
recumbency. Ergot, 414, especially ergotin 
subcutaneously, has been very effective. Gal- 
vano-puncture, 288, has but rarely succeeded. 
Angina Pectoris: 

Amyl Nitrite, 593, by inhalation, affords prompt 
relief in cases characterized by elevated arterial 
tension, but must be used with caution when 
arteries are atheromatous and heart is fatty. 
Nitro-glycerin, 596, acts similarly but more 
slowly, and is more manageable. Arsenic,152, 
in full doses, is very efficient as a means of pre- 
vention. Ether, 4S9, in small quantity by in- 
halation, may abort a mild attack, hypoder- 
matically, in the worst cases, 490. 
Antidotes : 

For the Mineral Acids, 95. Alkalies, soda, lime- 
water, soap, and protectives, as oil, mucilage, 
etc. For the systemic depression: alcohol, 
opium, and especially carbonate of ammonia. 

For Phosphorus, 110. Emetic of sulphate of cop- 
per, French turpentine, or old, unrectified tur- 
pentine, hydrated magnesia, laxatives, trans- 
fusion. Oils and fats aid the absorption of 
phosphorus, but mucilaginous protectives are 
useful. 

For Arsenic, 146. Hydrated sesquioxide of iron,, 
dialyzed iron, hydrated magnesia, emetics, the 
stomach-pump ; opium and alcoholic stimulants 
for the systemic depression. 

For the Caustic Alkalies, 188. Diluted acetic 
acid, vinegar, soap, oil ; opium and stimulants 
for the systemic depression. 

For Barium, 216. Emetics, protectives, hydrat- 
ed magnesia, tannin, especially diluted sulphuric 
acid, and nitrite of amyl, and nitro-glycerin to 
counteract the elevated arterial tension. 

For Sulphxirous Acid and Sulphites, 220, and 
the Sulphides, 222. "Weak acids, chlorine-wa- 
ter, sulphate of iron, common salt, etc. 

For Iodine and its poisonous compounds, 228. 
Starch is the antidote for iodine; but, as the 
iodide of starch is not without power, emetics 
should also be given. Albumen, starch, lime- 
water, tannin, soap, etc., should be used in poi- 
soning by iodides, and free emesis should be 
induced. 

For Iodoform, 242. 

For Mercury and its compounds, 247. Albu- 
men, the carbonated alkalies, tannin, lime-wa- 
ter, should be administered freely. Emetics 
should be given. For the usual systemic symp- 
toms, opium, alcoholic stimulants, etc. 

For Gold and its Chlorides, 258. Same as for 
mercury. 



714 



CLINICAL INDEX. 



For Silver, 261. Common salt freely, albumen, 
tannin, and emetics. 

For Copper, 268, and Zinc, 278. Albumen, tan- 
nin, lime-water, soap, oil, and mucilage ; and 
the usual systemic remedies. 

For Lead, 273. Diluted sulphuric acid, alum, 
Epsom salts, milk ; emetics and purgatives, and 
iodides and bromides to secure elimination. 

For Antimony, 284. The vegetable astringents, 
tannin, albumen, oil, mucilage, and opium and 
stimulants to counteract the depression. 

For Nux Vomica and its Alkaloids, 392. Chlo- 
ral, ether and chloroform, gelsemium, bromide 
of potassium, are the physiological antagonists ; 
tannin is a chemical antidote. 

For Picrotoxin, 405. The physiological antago- 
nists and the antidotes are the same as for 
strychnia. 

For Ergot, 409. The caustic alkalies, aconite, 
but especially amyl nitrite. 

For Digitalis, 422. Aconite, saponaria, amyl ni- 
trite, and nitro-glycerin, are the physiological 
antagonists; tannin, sulphate and chloride of 
iron, are chemical antidotes. 

For Belladonna and its alkaloid Atropine, 435. 
Opium or morphine, physostigma or eserine, and 
pilocarpine, are the most efficient antagonists. 
The caustic alkalies destroy the active prin- 
ciple, but the available chemical antidotes are 
tannin, compound solution of iodine, charcoal, 
etc. 

For Stramonium, Hyoscyamus, and Duboisia. 
The antagonists and chemical antidotes are the 
same as for belladonna. 

For Camphor, 455. Caffeine the arterial seda- 
tive. 

For Cannabis Indica, 463. Caustic alkalies, 
strychnine, faradic electricity. 

For Chloroform.— By the stomach, 492. The 
stomach-pump, oil and mucilage, atropine, fara- 
dism, artificial respiration, and cold affusion. 
By inhalation, 498. Nelaton's method (inver- 
sion of the body), drawing out the tongue, arti- 
ficial respiration, faradism, ammonia by inha- 
lation and intravenous injection, amyl nitrite 
by inhalation, subcutaneous injection of tincture 
of digitalis. Oxygen, 319, by inhalation. 

For Chloral, 509. Ammonia, atropine, galvan- 
ism, and heat, to overcome the cardiac depres- 
sion. Strychnine is the antagonist of Liebreich, 
but its range is limited. Eserine, to a slight ex- 
tent, is physiologically opposed. 

For Opium, 518. The stomach-pump, or emetics 
(bicarbonate of sodium, followed by tartaric 
acid, has acted favorably) ; cold affusion, faradi- 
zation, and artificial respiration, when the res- 
piration flags ; belladonna, or atropine subcuta- 
neously, has acted favorably in numerous cases ; 
caffeine injected, or black coffee. 
For Conium, 551. Chemically the caustic alka- 
lies and tannic acid are antidotes ; emetics or 
the stomach-pump, cold affusion, artificial respi- 
ration. Atropine and strychnine, subcutane- 
ously, to counteract the respiratory depression. 
For Curara, or Woorara, 555. Caustic alkalies 
and tannin act chemically ; artificial respiration 



is of the highest importance ; atropine and 
strychnine counteract the respiratory failure. 
Cold affusion and emetics, or the stomach- 
pump, are necessary. 
For Gelsemium, 560. Chemically caustic alka- 
lies and tannic acid. Emetics, warmth, am- 
monia, faradization of chest-muscles, artificial 
respiration, and morphine, subcutaneously, are 
the important measures. 
For Pilocarpus, 567. The persalts of iron and 
the salts of the metals are chemically antidotal. 
Atropine is, in a very complete degree, the phys- 
iological antagonist ; cardiac stimulants, as am- 
monia and alcohol, antagonize the heart's weak- 
ness. 
For Physostigma, 574. The vegetable astrin- 
gents and tannin, chemical antidotes. Physio- 
logical antagonists are, atropine to a considerable 
extent — chloral, apparently, more completely. 
Faradization of chest-muscles and artificial 
respiration are important measures. Emetics 
should not be omitted. 
For Tobacco or Nicotine, 579. Emetics or 
stomach-pump. Tannin, compound solution of 
iodine, chemical antidotes. Ammonia, brandy, 
atropine, and strychnine to. overcome failure of 
respiration ; also, artificial respiration, cold affu- 
sion. 
For Hydrocyanic Acid and Cyanide of Potas- 
sium, 5S3, 5S9. Cold affusion to the spine, arti- 
ficial respiration, and the injection of atropine, 
are the best expedients. Emetics should be 
given if there is time. 
For Amyl Nitrite and Nitro-glycerin, 591, 
594. Ammonia, cold affusion, and artificial 
respiration, strychnine and atropine subcuta- 
neously, also ergot, a true physiological antago- 
nist. 
For Aconite and Veratrum Viride, 597, 602. 
Ammonia, alcohol, artificial respiration, heat, 
atropine, or morphine, subcutaneously; also 
digitalis. 
For Muscarine, 612. A complete antagonism 
exists between atropine and muscarine; also, 
digitaline and eserine are antagonists. 
For Chlorine, 321. Ammonia for the gas, and 

albumen for the solution. 
For Carbolic Acid, 323. Saccharate of lime, or 
lime, is a chemical antidote. Oils and glycerin 
must not be given, but vegetable demulcents 
used freely. Atropine is a physiological antago- 
nist of great value. Emetics should be used, 
and diluents. 
For Salicylic Acid and Besorcin, 335, 346. 
Arterial and respiratory stimulants prevent the 
cardiac depression, especially atropine. 
For the Rydragogue Cathartics, 648. Demul- 
cents, opium, and stimulants. 
For Turpentine, 661. Emetics, diluents, and 
demulcents. Opium is the most important 
remedy to counteract the local irritation and 
the cerebral effects. 
For Savin and Cantharides, 681. Emetics and 
demulcents. Opium to counteract the depres- 
sion and local inflammation ; also, stimulants and 
atropine for the cardiac depression. 



I 



CLINICAL INDEX. 



715 



Antipyretics : 

Quinine, 177, first in importance, but must be 
given in full doses. Eucalyptus, 164, useful 
in chronic malarial poisoning. Digitalis, 425, 
chiefly useful as an adjunct to quinine. Sali- 
cylic Acid, or salicylates, 341, active and cer- 
tain antipyretics. Eesorcin, 348, Chinoline, 
Kairine, and Hydroquinone, 350, new and 
valuable agents to reduce fever- heat. Cold 
Baths, 66, 67, the most powerful means of 
lowering temperature. Pilocarpus, 568, re- 
duces fever after a preliminary stimulation. Of 
lesser importance are Aconite, 600, Gelsemium, 
563, and Phytolacca, 611. 

Antiseptics : 

Carbolic Acid, 328, Salicylic Acid, 345, Boracic 
Acid, 352, Resorcin, 351, Quinine, 177, are the 
most important for the antiseptic method. 
Thymol, 357, Myrtol, 357, Oxygen, 319, Chlo- 
rine, 320, Bromine, 321, Sulphurous Acid, 
221, etc., are of minor importance. Benzoates, 
855. Sulphocarbolates, 332. 

Aphonia : 
Atropine, 435, is certain, nearly, in hysterical 
cases, if given to induce some obvious consti- 
tutional symptoms. Nitric Acid, 100, is very 
effective in the hoarseness of singers, when the 
aphonia is reflex from stomach disorder, and in 
fatigue of vocal cords. Electricity, 384, by an 
intra-laryngeal electrode, cures, usually, paresis 
of the vocal cords. 



Bismuth, 142, in powder directly to the ulcers. 
Coptis, 153, the infusion as a topical applica- 
tion. Chloride of Potassium, 192, probably 
the most effective remedy, locally, and by the 
stomach; full doses are necessary. Iodide of 
Potassium, 230, in solution, an excellent top- 
ical application. Quinine, 176, highly useful as 
a tonic. Muriatic Acid, 96, a local applica- 
tion to ulcers, formerly more employed than at 
present. Sulphurous Acid, 221, well diluted, 
in the form of spray. Carbolic Acid, 330, 
pure, applied to ulcers, an anaesthetic and alter- 
ant. Chlorine, 320. 

Apoplexy. (See Hemorrhage, Cerebral.) 

Arthritis, Chronic Rheumatic : 
Alkalies, 200, especially lithium. Iodide of Po- 
tassium, 234. Cimicifuga, 433. Salicylates, 
342 ; especially in debilitated subjects, Salicy- 
late of Cinchonidine. Arsenic, 154, persist- 
ently used in small doses. Cod-Uver Oil, 107, 
with or without the phosphates. 

Ascarides : 

Quassia, 163, also Eucalyptus, 160, an infusion 
as a rectal injection, or by irrigation of the 
bowel. Carbolic Acid, 324, is an efficient but 
unsafe parasiticide when injected in the rectum. 
Iron, 129, the sirup of the iodide, by the stom- 
ach to prevent reproduction, and the tincture 
by rectal injection. Santonin, 656, at night, 
with or without calomel, and a laxative in 
the morning. Enema Aloes, 653. Hydrocy- 
anic Acid, 5S8, for lumbricoides. Salicylic 
Acid, 340, by enema and by stomach. Myrtol, 
357. 



Ascites : 
Copaiba Resin, 667, has proved very efficient as 
a diuretic. Pilocarpine, 571, very service- 
able when given to produce free diaphoresis. 
Jalap, 643, in the form of the compound pow- 
der, most useful as a hydragogue cathartic. 
Elateriurn, 651, also a hydragogue of great 
power ; must be given cautiously, and not at 
all when gastro - intestinal irritation exists. 
Eemedies are more active when aided by a 
milk-diet, 46, or by dry diet, 41. 

Asthma : 
Air, compressed, 82. Oxygen, 319, pure or di- 
luted, by inhalation. Amyl Nitrite, 593, by in- 
halation, or Nitro-glycerin,596, by the stomach. 
Arsenic, 152, by the stomach, as a prophylactic, 
or by smoking in cigarettes. Bromides, 547, 
relieve in purely spasmodic asthma, but soon 
lose their effect. Chloral, 513, may arrest the 
paroxysms, but danger of chloral-habit. Chlo- 
roform, 492, by inhalation, dropped on warm 
water, relieves, but a habit is quickly formed. 
Last two remedies are dangerous in weak 
heart. Ether, 491, is safer and equally efficient 
by inhalation. Quebracho, 618, a new and 
valuable remedy in most forms of dyspnoeas 
Hyoscine, 451. Belladonna, 439, in pastile. 
with stramonium and other narcotics, gives 
temporary relief, but Atropine, hypodermatical- 
ly, is more efficient. Morphine, 535, and atro- 
pine subcutaneously, give more decided and 
lasting relief than any other remedies. Grin- 
delia, 609, is a most useful remedy, next in 
value as a means of immediate relief to mor- 
phine and atropine. Iodide of Potassium, 231, 
in full doses, succeeds remarkably in some 
cases. Ethyl Iodide, 239. Quinine, 183, as a 
tonic after the acute symptoms and as a pro- 
phylactic in the interval. Strychnine, 400, is 
indicated when there is weakness of respiratory 
muscles. Galvanization, 386, of the pneumo- 
gastric and cervical sympathetic relieves the 
spasmodic difficulty of breathing, and some- 
times effects a cure, and faradization of the 
chest-muscles has lately been reported success- 
ful in effecting a cure. Tartar Emetic, 2S6, 
and Lobelia, 584, carried to slight nausea in 
cases of deficient secretion of bronchial mucus. 
Pilocarpus, 571, in humid A. 

Astigmatism : 
Atropine, 442, a weak solution to facilitate exam- 
ination. Duboisine, 453, a substitute. Eserine, 
578, in some cases. 

Atheroma of the Vessels: 
Arsenic, 152, indicated when eyes are puffy, 
breathing short, and ankles swollen. Phos- 
phorris. 317, in minute doses for the weakness 
and mental failure associated therewith, with or 
without Cod-liver Oil, 108, which may also be 
advantageously combined with phosphates and 
hypophosphites. Quinine, 183, is of great ser- 
vice, administered in a full dose daily for a 
time. 

Bed-sores : 
Alcohol, 479, a wash to skin. Alum, 295, with 
tincture of camphor and whites of eggs, a good 



716 



CLINICAL INDEX. 



topical application. Copaiba, 667, and Castor- 
Oil, equal parts, one of the best. A galvanic 
couplet, zinc and silver, connected with a cop- 
per wire, has been used with success, 389. 

Biliary Calculi. (See Calculi.) 

Biliousness : 
Acids, Mineral, 97, before meals in acid indiges- 
tion. Hydrochloric acid and pepsin after meals 
in atonic dyspepsia. Alkalies, and their laxa- 
tive salts, 193, and Alkaline Mineral- Waters, 
205, when the uric acid is in excess. Aloes and 
the resin-bearing cathartics, 642, to promote 
biliary evacuations. Calomel and blue pill, 636, 
in small quantity as laxatives merely. Muriate 
of Ammonia, 213. Manganese, 137, in gouty 
subjects. Iodide of Ammonium, or iodine, 
230, in the biliousness of the malarial cachexia. 
Hydrastis, 166, Stillingia, 311, and the bitters, 
also, Tincture of Nux Vomica, 39S, after the 
action of saline or resinous cathartics. Milk- 
Diet, 46, 47, 59, of high importance. 

Bites of Venomous Snakes: 
Ammonia, 213, Bromine, 322, locally to the 
wound. Alcoholic Stimulants, 477. Chlo- 
rinated Lime, 321. 

Bladder, Cataerh of : 
Alkalies, 194, after meals, when urine is acid. 
Benzoate of Ammonia, 354, when urine is 
alkaline. Copaiba, 667, Cubebs, 669, Buchu, 
676, Juniper, 672, and other urino-genitals, are 
useful, but liable to damage kidneys. Canthar- 
ides Tincture, 681, very efficient in small 
doses. Eucalyptus, 164, and Turpentine, 665, 
Quinine, 1S4, very beneficial when there is also 
prostatic disease. 

Bladder, Ikeitabilitt of : 
Belladonna, 441, of special utility in nocturnal 
incontinence, but must be carried to the pro- 
duction of physiological effects. Cantharides 
Tincture, 6S1, sometimes succeeds remarkably 
in irritable bladder of women. Aqua-punc- 
ture, 690, often curative. When urine is acid, 
Alkalies, 194; when alkaline, Benzoate of Am- 
monia, 354. 

Boils : 
Arsenic, 153, long continued for a succession of 
boils. Nitrate of Silver, 265, dissolved in 
nitrous ether, and painted on early to abort 
boils. Sulphides, 223, in small doses frequent- 
ly, either stop formation or terminate by ex- 
trusion of pus. Sulphurous Waters, 224, act 
in same way. Phosphates, 122, suitable tonics. 

Bone Diseases ; Softening of Bone : 

Carbonate and Phosphate of Lime, 121, 199, 
materials necessary. Phosphorus, 116, to pro- 
mote formation of bony tissue. Phosphates, 
121, to improve tissue formation in general. 
Cod-liver Oil, 107, in combination. Chloride 
of Calcium, 199, in strumous subjects. (See 
also C ABIES, Kickets.) 

Breath, Foul : 

Chlorine-Water, 320, properly diluted. Car- 
bolic Acid, 327, in dilute solution, as a mouth- 
wash, and by the stomach. Potassa, Perman- 
ganate, 200, in rose-water as a mouth-wash. 
Benzoic Acid, 355. 



Bright's Disease : 
Milk- Cure, 46, 47, has been very successful, es- 
pecially an exclusive skim-milk diet, or a diet 
composed largely of milk. Water, 65, and large 
draughts of weak alkaline waters. Bitartrate 
of Potassa, 195, as lemonade, drunk freely as a 
diuretic. Digitalis, 428, the infusion for dropsy. 
Iodide of Potassium, 233, in cases of chronic 
kind, and especially if a syphilitic taint is 
known to be the cause. Iron, 134, the tinc- 
ture of the chloride, well diluted, or in Basham's 
mixture, to stimulate the kidneys and to re- 
lieve the accompanying anaemia. Jaborandi^ 
571, highly useful in many cases of uraemia. 
Aurum, 259, in chronic interstitial nephritis 
and amyloid kidney. Cantharides, 681, Euca- 
lyptus, 164, and other urino-genitals, but are 
doubtful. Nitro- glycerin, 596, has had some 
remarkable successes. 

Beonchitis, Acute : 
Muscarine, 615, at the onset of the disease may 
arrest. Aconite, 600, in small dose frequently. 
Tartar Emetic, 2S6, in moderate quantity, 
with or without morphine. Nitric Acid dilute, 
100, Cimicifuga, 433, an expectorant, may be 
combined with opium and aconite. Carbonate 
of Ammonia, 214, if secretion is viscid and 
there is depression. Sanguinaria, 314, and 
Lobelia, 5S5, nauseating expectorants, best 
given with opium. Morphine, or Dover's 
Powder, with quinine, 183, may abort if given 
early enough. Pilocarpus, 571, often highly 
useful at the beginning. For mild cases, Sirup 
of Squills, 676, or the compound sirup, 676, 
with Paregoric, makes a useful combination. 
Ipecac, 628, as expectorant. 

Bronchitis, Capillary : 
Iodides, 231, diminish the viscidity of the secre- 
tion, and thus lessen one of the chief dangers. 
Ethyl Iodide, 235. Carbonate of Ammonia, 
214, acts similarly, and is indicated when de- 
pression comes on. Serpentaria, 161, a stimu- 
lating expectorant, may be given with ammo- 
nia. Turpentine, 665, when the capillary 
circulation languishes; Camphor, 457, also, 
under the same circumstances. Emetics are 
highly useful, the Subsulphate of Mercury, 
620, Alum, 620, and Apomorphine, 622, being 
the principal. Pilocarpus, 571, when there is 
much secretion. 

Bronchitis, Chronic : 
Koumiss, 46, a valuable nutrient. Cod-liver Oil, 
106. Iron, 132, especially the mistura ferri 
composita. Chloride of Ammonium, 214, 
combined with stimulating expectorants, as 
Eucalyptus, 164, or Serpentaria, 161, or San- 
guinaria, 314. The Iodides, 231, especially 
the iodide of ammonium, is serviceable in com- 
bination with the expectorants just named. 
Morphine, 533, or some preparation of opium, 
is indispensable to quiet cough. Strychnine, 
401, and the sirup of the phosphate of iron, 
quinine, and strychnine, is a valuable respira- 
tory stimulant. Strychnine is the best remedy 
to check the reflex vomiting. Inhalations of 
Sulphurous Acid, in spray or gas, 221, of Car- 



CLINICAL INDEX. 



717 



boUc Acid, 327, and of the Benzoates, 354, are 
very useful. Grindelia, 609, a valuable expec- 
torant, especially when the cough is trouble- 
some. Copaiba, 667, and Cubeb, 669. 

Bronchorrhcea : 
Eucalyptus, 164. Turpentine, 665, and the 
stimulating expectorants mentioned under 
chronic bronchitis. Carbolic Acid, 327, inter- 
nally and by spray. Grindelia, 609, Muriate 
and Carbonate of Ammonia, 214. Cubeb, 669, 
Copaiba, 667. Sulphurous Acid, spray, 221, 
Benzoin, inhalation, 355. Myrtol, 35S, antisep- 
tic; eliminated by the lungs. Cod-liver Oil, 
106. Alcoholic Stimulants, 479. Oxygen, 319, 
inhalations. Iodides, 231. Quinine, 1S4, and 
the Phosphates as restoratives, 122. 

Burns and Scalds : 
Carbonate of Soda, 201, in saturated solution to 
relieve pain. Boracic Acid, 352, most useful 
in Mr. Lister's hands. Carbonate of Lead, 
277, painted on. Turpentine, 665, mixed with 
basilicon-ointment. Salicylic Acid, 345. Car- 
bolic Acid, 329, one-per-cent solution relieves 
pain and prevents suppuration. Collodion, 
69S, the flexile for slight burns. 

Cachexia : 
Aliment, 53, of first importance. Air, 82. Mas- 
sage, 85. Oils and Fats, 106, and oil inunc- 
tioDS. Iron, 131, and Chalybeate Waters, 140. 
Manganese, 137, especially Sirup of the Io- 
dide of Iron and Manganese. Arsenic, 154. 
Phosphates, 121. The Simple Bitters, 160. 
Eucalyptus, 1C3. Hydrastis, 166, Quinine, 
Cod-liver Oil, 107. 

Calculi, Biliary : 
Aliment, 52. Starches, sweets, and especially 
fats, should be avoided. Alkaline Mineral 
Waters, 205, highly useful. Phosphate of Soda, 
121, persistently used. Turpentine, 662, remedy 
of Durand. For the paroxysms, see Colic. 

Calculi, Kenal : 
Alkalies, 194, 200, when the calculi are uric, the 
potash, and not the soda salts. Also, Alkaline 
Mineral- Waters, 205, Yichy, Bethesda, etc. 
Benzoate of Ammonia, 355, for the solution of 
phosphatic calculi. Very long-continued use of 
the solvent necessary. Borocitrate of Mag- 
nesia, 352, solvent for uric-acid calculi. Tar- 
troborate of Potassium, 353, probably still 
more efficient. 

Cancer : 
Arsenic, 150, 155, relieves the pain and retards 
the growth of carcinoma of the stomach, and 
also of epithelioma. Bismuth, 143, relieves the 
vomiting in cancer of the stomach; also, Car- 
bolic Acid, 330, which, also, Injected beneath a 
cancer mass and applied to the ulcerated sur- 
face, retards the growth and allays pain. Po- 
tassa Chlorate, 201, applied in powder alters 
the ulcerated surface. Iodoform, 236, and Sali- 
cylic Acid, 345, also in powder to the surface 
of the cancer. Zinc Chloride and Sulphate 
dried, 281, are efficient caustics. Potassa 
Fma, 201, Chromic Acid, 201, 695, and Bro- 
mine, 322, also active escharotics for the de- 
struction of morbid growths. 



Caries : 

Cod-liver Oil, 107, to promote constructive met- 
amorphosis. Phosphates, 121, and Carbonate 
of Lime, 199, furnish needed materials. Chlo- 
ride of Calcium, 199, is useful in the strumous 
cachexia. Phosphorus, 117, promotes bone 
formation. Villatte's solution used to dissolve 
carious bone. 

Catarrh, Acute ; Common Cold : 
Aconite, 600, for the preliminary fever, with 
Belladonna, when secretion is excessive. 
Quinine and Morphine, 176, 183, may, at the 
outset, abort an attack. Ipecac, epecially the 
fluid extract, 625, alone or in combination with 
opium and aconite. Tartar Emetic, 286, in 
minute doses with morphine, is very useful. 
\ Dover's Powder, 533, at the inception may ar- 
rest the attack. Iodides, 231, a small dose 
very frequently, and Inhalations of Iodine, 
232. Ammonia, 215, carefully inhaled at the 
outset of the disease. Pulsatilla, 608, acts 
similarly to aconite, but is contraindicated if 
gastro-intestinal irritation exist. 

Catarrh, Broncho-Pulmonary: 
Air, compressed, 82. Alum, 295, by insufflation. 
Aconite, 600, when attack is recent. Bella- 
donna, 438, when secretion is profuse. Euca- 
lyptus, 164, Hydrastis, 166, Sanguinaria, 314, 
and Prunus Yirginiana, 162, after the acute 
symptoms have subsided. Also, Cubeb, 669, 
Copaiba, 667, Turpentine, 664, Carbolic Acid, 
327, of great value by spray inhalation. 

Catarrh, Chronic Nasal : 
Alum, 295, in powder by insufflation. Iodoform, 
and Tannin, 236, also applied in powder by 
insufflation. Iodine, 231, in vapor inhaled; 
also Bromine, 322, but it must be inhaled very 
cautiously. Ethyl Iodide, by inhalation, 239. 
Sanguinaria, 314, the tincture Internally and 
the powder locally. Cubeb, 669, in powder by 
insufflation and troches. 

Catarrh, Gastric. (See Gastric Catarrh.) 

Catarrh, Intestinal. (See Dysentery and Di- 
arrhoea.) 

Catarrh, Gentto-TJrinary. (See Bladder, Ca- 
tarrh of, Cystitis, Gonorrhoea, Leucorrhcba, 
Prostorrhcea, Endometritis, etc.) 

Cerebral Anaemia : 
Iron, 132, and Chalybeate Mineral- Waters, 141. 
Galvanism, 381, by transverse applications. 
Phosphorus, 116, and Phosphates, 122, Qui- 
nine, 183, Strychnine, 398, and the cerebral 
excitants, Caffeine, 469, Guarana, 470, etc. 
Arsenic, 152, is highly efficient in some hypo- 
chondriacal cases ; also, Aurum, 260, Amyl 
Nitrite, 593. Nitro- Glycerin, 596, and Ammo- 
nia, 213, afford relief in sudden attacks. 

Cerebral Congestion : 
Aconite, 601, Cold Douche, 69, alternate hot and 
cold applications. Bromides, 543, highly use- 
ful. Ergot, 415, Gelsemium, 562, Hydrocy- 
anic Acid, 5S8, and the arterial sedatives, Ye- 
ratrum Viride, 605, Digitalis, 427, etc. Gal- 
vanization of the cervical sympathetic, 382. 
Venesection, 694, is a suitable remedy in cases 
threatening rupture of vessels. Active Ca- 



718 



CLINICAL INDEX. 



tharlics, 634, Colchicum, 307, lessen blood- 
pressure and act by derivation. 

Cerebro-Spinal Meningitis : 
Aconite, Tincture, 601, carried to arterial de- 
pression before exudations. Ergot, 415, also, 
for first stage or period of congestion and irri- 
tation. Gelsemium, Fluid Extract, 562, for 
same period. Opium, 531, is tbe most effec- 
tive remedy. Quinine, 179, full cinchonism 
at tbe onset of the disease. Cold Baths, 69, 
71, for hyperpyrexia. 

Chancre. (See Syphilis.) 
Bromine, 322, Chromic Acid, 695, Nitric Acid, 
101, and Acid Nitrate of Mercury, 255, effi- 
cient escharotics for the destruction of chan- 
cre. Iodoform, 236, with or without Thymol, 
357, an excellent application dusted over sore. 
Carbolic Acid, 329, applied pure in mild 
cases. Iodide of Iron, 130, internally in cases 
of systemic depression or sloughing phagedse- 
na. Chlorate of Potassa, 201, in powder, is 
also an excellent local application. 

Chilblains : 
Turpentine, 665, Tincture of Iodine, 236, Car- 
bolic Acid, 830, with iodine and tannin. Sul- 
phurous Acid, diluted with glycerin, 221, is 
an excellent application. 

Chloroform Narcosis. (See Antidotes, Nar- 
cosis.) 

Chlorosis : 
Arsenic, 151, as an adjunct to, or substitute for, 
iron. Oxygen, 319, inhaled. Iron, 130, with or 
without arsenic; with aloes if constipation 
exist. Chalybeate Springs, 142. Massage, 
86, oil inunctions, 106, and faradization. Gal- 
vanization, 386, to central nervous system. 
Nux Vomica, or strychnine, 398, stimulates the 
blood-making organs; may be combined with 
iron. Pepsin, 90, Pancreatin, 90, improve 
digestion. 

Cholera Asiatica : 
Acetate of Lead, 275, an excellent astringent, 
usually given with opium and camphor. Cam- 
phor, 456, the saturated tincture. Carbolic 
Acid, 327, with or without iodine. Chloral, 
512, is highly effective by subcutaneous injec- 
tion; usually combined with morphine. Chlo- 
roform, 494, a few drops frequently to stop 
vomiting. Opium, 527, especially useful to ar- 
rest preliminary diarrhoea. Calomel, 251, mi- 
nute doses will sometimes stop vomiting. Alco- 
hol, 477, as iced brandy or champagne to arrest 
vomiting and stimulate the heart. Sulphuric 
Acid, 98, with opium tincture, an excellent 
remedy for cholera diarrhoea. Arsenic, 151, 
Fowler's solution with opium, sometimes val- 
uable. Strychnine, 398, has been used with suc- 
cess in some epidemics. Atropine, 438, to 
stimulate the heart in cholera asphyxia. Intra- 
venous Injection of Salines, 16, in the algid 
stage, and of Milk, 20. 

Cholera Morbus : 

Morphine and Atropine, 527, hypodermatically, 

the most efficient remedy. Chloral, 542, with 

morphine if cramps occur. Carbolic Acid and 

Bismuth, 326, in an emulsion together, are suf- 



ficient in mild cases. The remedies for Chol- 
era A., also. Cajepul- Oil, 357. 

Cholera Infantum : 
Aliment, 47, 52, is of the highest importance. 
Carbolic Acid, 326, with or without bismuth, 
is very effective. Bismuth, 143, is frequently 
prescribed in an emulsion. Oxide of Zinc, 280. 
Calomel, 251, in minute doses, arrests vomit- 
ing. Sulphate of Copper, 270, is an effective 
remedy, but only the smallest doses are admis- 
sible. Bromide of Potassium, 542, is highly 
useful in cases characterized by nervous irrita- 
bility and feverishness. Ipecacuanha, 627, is 
a desirable remedy when the stools assume a 
dysenteric character. Brandy, 477, renders 
important service in most cases, but full doses 
are necessary. Camphor is indicated when de- 
pression is marked ; it may be given in milk. 
Nitrate of Silver, 264, beneficial aftar the acute 
symptoms. Opium, 527, must be given with 
great caution. 

Chordee : 

Camphor, 457, successful if given in sufficient 
quantity; may be administered with lactuca- 
rium. Bromides, 548, occasionally give relief. 
Cantharides Tincture, 682, in small dose, is 
said to be useful. Morphine and Atropine, 
535, subcutaneously, is the most certain. Col- 
chicum, 307, in a nightly dose will succeed. 
Tartar Emetic, 287, will relieve if carried to 
nausea. Tobacco, Wine of, 5S2, a few drops at 
bed -hour. Lupuline, 538, not powerful. 

Chorea: 

Water, 70, cold affusion and cold baths. Iron, 
132, especially subcarbonate, for the condition 
of anaemia and amenorrhcea. Cod-liver Oil, 
108, when the nutrition is poor. Arsenic, 152, 
one of the most certain remedies, but large 
doses are required, and well borne. Strych- 
nine, 400, and especially Picrotoxin, 407, in 
full doses when the nervous element is pre- 
dominant. Cimicifuga, 433, useful in cases 
with menstrual derangement. Conium, 552, 
especially succus conii, has been strongly urged 
by Harley. Morphine, 531, in the large doses 
readily borne, and Chloral, 513, especially at 
night, are highly useful. Static Electricity, 
386, has lately been revived. Magnets, 3S5. 
Metallotherapy, 292. Chloride of Calcium, 
199, has done good in strumous subjects. Can- 
nabis Indica, 465. 

Cirrhosis : 
Iodides, 230, with or without arsenic, are useful 
in first stage. Phosphate of Soda, 121, per- 
sistently administered, of real value if com- 
menced early. Chloride of Gold, 259, has 
seemed to have curative power if given in time. 
Arsenic, 151, and Phosphates, especially Phos- 
phate of Soda, 121, appear also to retard over- 
growth of connective tissue. Stillingia, 311, 
and Hydrastis, 166, in incipient disease, sec- 
ondary to intestinal catarrh. 

Colic : 
Asafmlida, 459, in the flatulent colic of infants. 
Chloroform, 492, useful in flatulent colic, and 
in hepatic, a few drops frequently. Ether, 489, 



CLINICAL INDEX. 



719 



501, internally and by inhalation. Camphor, 
456, a few drops of the saturated tincture fre- 
quently. Infusum Tabaci, 5S2, as an enema, 
effective but dangerous. Morphine, 527, hypo- 
dermatically, the most prompt and successful 
remedy. 

Colica Pictonum : 
Alum, 293, overcomes the constipation with suc- 
cess ; may be given with dilute sulphuric acid. 
Sulphuric Acid, 100, very dilute in "lemon- 
ade," as prophylactic and as a curative agent. 
Morphine, 527, subcutaneously, relieves pain 
most quickly. Iodides, 234, and Bromides, 
543, to cause excretion of lead. Sulphate of 
Magnesia, 634, to overcome constipation. 

Colic, Hepatic : 
Tor the pain — Morphine and Atropine, 527, 
subcutaneously. Spirit of Chloroform, 492, 
Ether, internally and by inhalation. Nitro-gly- 
cerin, 501, and Amyl Nitrite. For the calculi 
—AUment, 52, Phosphate of Soda, 121. Chlo- 
roform, 492, a few drops ter die persistently 
used. Remedy of Durande, 4S9. Alkaline 
Mineral- Waters, 205. (See Calculi, Bil- 
iary.) 

Condylomata : 

Calomel, 256, dusted over. Iodoform, 236, pow- 
der applied freely. Carbolic Acid, 330, a mild 
escharotic for simple cases. Chromic Acid, 
695, in paste to destroy ; solution of bichromate 
of potassa a useful lotion. Nitric Acid, 101, a 
dilute solution as a wash. 

Conjunctivitis : 

Calomel, 257, dusted over membrane. Yellow 
Oxide of Mercury, 256, an ointment of, with 
vaseline, a most efficient remedy for granular 
lids. Tannin, 303, in powder dusted over 
membrane, an excellent application. Bismuth, 
144, also applied in powder directly. Copper 
Sulphate, 271, a smooth crystal applied direct- 
ly, an approved remedy. Silver Nitrate, 267, 
a long-standing, useful agent. Zinc Sulphate, 
2S2, a weak solution in rose-water, one of the 
best remedies for simple conjunctivitis. Cad- 
mium, 2S8, in solution, a substitute for copper 
and zinc. Fluid Extract of Ergot, 414, applied 
undiluted, is said to be very efficient. 

Constipation : 
Aliment, 52, highly important in habitual ; bread 
of unbolted flour, corn-meal bread, fruits, and 
succulent vegetables. Cathartics, 629. Physi- 
ological laxatives ; Arsenic, 151, small doses of 
Fowler's solution increase action. Nux Vomi- 
ca, 398, Physostigma, 576, Belladonna, 438, 
Tabaci Yinum, 581, Muscarine, 615, all act by 
either increasing secretion or muscular action, 
or both. Faradisation, 384, of intestines. 
Saline Mineral- Waters, 206, and the purga- 
tive Sulphurous Waters, 227. Enemata, 653. 

Convalescence : 
Koumiss, 46, a valuable reconstituent stimulant. 
Bitters, 160, the simple, especially calumba and 
gentian. Eucalyptus, 163. a tonic of special 
utility after malarial diseases. Hydrastis, 166, 
tonic, and useful substitute for quinine. Cuca, 
467, a tonic and stimulant of the nervous sys- 



tem; also, Guarana, 469, belonging to the 
same class. Iron, 129, especially sirup of the 
iodide, the carbonate, sulphate and tincture of 
the chloride. Phosphates, 121, and Phosphites, 
121. Cod-liver Oil, 106, Pepsin, 89, and Pan- 
creatin, 89. Wine, 4S3. 
Convulsions : 
Ano&sthetics, 503, in uraemic and puerperal con- 
vulsions. Bromides, 545, in epileptic and epi- 
leptiform. Chloral, 513, in puerperal, uraemic, 
and epileptiform. Morphine, 531, hypoder- 
matically, in full doses, in uraemic convulsions. 
Yeratrum Yiride, 606, in puerperal. 
Cough : 
Asafoetida, 460, in cough by habit, bronchorrhcea 
and chronic bronchitis ; also, under same con- 
ditions, ammoniac, cubeb, copaiba, turpentine, 
etc. Chloral, 513, in spasmodic cough, cough 
by habit, whooping-cough, etc. Gelsemium, 
562, useful to quiet a nervous element in cough. 
Lobelia, 5S3, a nauseating expectorant of great 
utility in dry cough, bronchitis, asthma, etc. 
Cerium, 2SS, in cough associated with, or reflex 
from, stomach derangement. Opium, 533, in 
some form, of chief utility as a means of quiet- 
ing cough. Prunus Virginiana, 162, anodyne 
and tonic expectorant. Hydrocyanic Acid, 
5SS, indicated in cough of irritation, habit, re- 
flex, and stomachal. Grindelia, 609, especial- 
ly useful in spasmodic cough, and as a stimu- 
lant expectorant in chronic bronchitis. Lac- 
tucarium, 538, sirup, an excellent vehicle for 
cough-mixtures. Ipecacuanha, 62S, especially 
the fluid extract, an excellent nauseating expec- 
torant. 
Ceoup. (See Laryngismus Stridulus.) 
Alum, 295, emetic not depressing. Mercury 
Subsulphate, 252, the most efficient emetic in 
croup. Calomel, 252, by some supposed to be 
sedative and aplastic, allaying laryngeal spasm 
and preventing formation of membrane. Sul- 
phate of Copper, 270, Sulphate of Zinc, 280, 
as emetics inferior to turpeth mineral. Tartar 
Emetic, 2S5, causes dangerous depression in 
young children. Apomorphine, 622, effective 
but liighly dangerous. Quinine, 184, in large 
doses highly useful. Lactic Acid, 93, a solvent 
of false membrane, applied in spray or directly. 
Carbolic Acid, 321, in spray. Lime- Water, 
199, steam by slaking lime. Ipecac, 665, as an 
emetic. 
Cysts : 
Iodine, 237, tincture or compound tincture in- 
jected is effective. Nitrate of Silver, 267, a 
solution injected into cysts to excite adhesive 
inflammation. Galvano-puncture, 388, will 
usually permanently occlude. 
Cysts, Hydatid, of Liver or elsewhere : 
Iodine Injections, 237. Galvano-jmncture, 388. 
Simple Acupuncture, 6S9, and escape of some 
fluid, often suffices. 
Delirium Tremens : 
Alcohol, 47S, of great utility when assimilation 
can not proceed without it. Bromides, 543, 
may cure the preliminary "horrors," and suc- 
ceed in mild cases of delirium tremens. Chlo- 



720 



CLINICAL INDEX. 



ral, 513, very effective, but dangerous in old 
topers and cases of weak heart. Chloroform, 
493, by the stomach, lessens delirium and pro- 
cures sleep. Arnica Tincture, 565, highly 
serviceable when there is much depression. 
Digitalis, 427, 428, tincture or infusion, espe- 
cially the former, in full doses in cases with 
cardiac depression, anaemia of brain, due to low 
tension and lessened vis-a-tergo. Opium, 531, 
must be given cautiously, and the attempt to 
overwhelm the brain avoided. Quinine, 183, 
to restore digestion and support the powers of 
life. Cannabis Indica, 465, sometimes is re- 
markably quieting. Carbonate of Ammonia, 
214, required in condition of depression. Cap- 
sicum, 671, has hypnotic effects of great value 
in mild cases. 

Dementia Paralytica: 
Paraldehyde, 4S6, as a calmative. Physostig- 
ma, 577, has seemed to retard the progress. 
Chloride of Gold and Sodium, 260. 

Diabetes : 
Aliment, 43, 53, all saccharine and starchy foods 
excluded. The Milk-Cure, 46, has succeeded 
remarkably in some cases ; Buttermilk, 47, may 
be better. Alkalies', 193, and Alkaline Min- 
eral- Waters,205, of great value in the delirium 
of obese subjects. Arsenic, 154, in thin sub- 
jects, is often combined advantageously. Ar- 
seniate of soda, with phosphate of soda and the 
Phosphates, 122, which are also useful of them- 
selves. Lactic Acid, 93, has sometimes done 
good. Oxygen, 319. Salicylic Acid, 344. 
Opium, 533, especially the alkaloid codeine, 
restrains the waste of sugar. Chloride of Gold, 
259, is a promising remedy. 

Diabetes Insipidus : 
Pry Diet, 42. Ergot, 417, is one of the most 
efficient remedies. Pilocarpus, 572, has done 
good in some cases. Valerian, 462, restrains 
the flow but does not cure. Muscarine, 616, 
has been used with apparent success. Aurum, 
259, the chloride has been useful in some cases. 
Iodide of Potassium, 233, has cured cases of 
syphilitic origin. 

DlABRHOEA : 

Chalk, 199. in the diarrhoea of children, mistura 
cretce, with or without opium. Calomel, 251, 
in minute doses, or hydrarg. cum creta, when 
the stools are pasty and whitish. Bismuth, 
143, is useful, but large doses are necessary. 
Zinc Salts, 280, especially the Oxide, 280, 
which may be given with bismuth, or the sul- 
phate with morphine in the diarrhoea of adults. 
Sulphate of Copper, 270, is the most efficient 
of the mineral astringents in chronic diarrhoea ; 
is usually combined with opium. Arsenic, 151, 
Fowler's solution, with tincture of opium when 
undigested food is passed soon after meal, and 
in chronic diarrhoea. Mineral Acids, 98, espe- 
cially sulphuric, in profuse watery stools, or 
Hope's mixture. Acetate of Lead, 275, one of 
the most generally useful astringents. Cam- 
phor, 456, with or without opium, for summer 
diarrhoea. Ergot, 414, has proved very success- 
ful in some epidemics. Tannic Acid, 300, and 



vegetable astringents containing it, especially 
rubus, kino, catechu, are much employed in 
simple diarrhoea. Aliment, 43, 46, 52, milk- 
cure, raw-meat pulp, but caution is necessary 
in respect to the latter, because of danger of 
taeDia. Salicin, 334. 

Diphtheria : 
Belladonna, 440, useful at outset to check exu- 
dation, and later to support weak heart. Car- 
bolic Acid, 328, locally, in solution and spray, 
and systemically. Chlorine, 320, aqua chlo- 
rinii and chlorinated lime and soda topically to 
correct fetor and destroy germs. Lactic Acid, 
93, one of the best solvents. Sulphurous Acid, 
221, an antiseptic, in spray of dilute solution to 
fauces. Nitrate of Silver, 265, local application 
to fauces now but little used. Potassa Chlo- 
rate, 192, more largely used than any remedy, 
topically, and by the stomach. Iro.i, 181, tinc- 
ture of the chloride much employed, undiluted 
to the fauces, and by the stomach in full doses ; 
also largely prescribed with potassa chlorate. 
Muriatic Acid, 96, was formerly applied to 
exudation. Salicylic Acid, 341, and the salicy- 
lates, the former also locally, to reduce tem- 
perature and prevent systemic infection. Re- 
sorcin, 349, acts similaily to carbolic and sali- 
cylic acids. Alcohol, 477, very much prescribed 
for support and to prevent diffusion of the poi- 
son. Kecently Pilocarpus, 573, has been brought 
forward as a remedy, but reports are conflicting. 
Benzoate of Sodium,, 855, has been used with 
great success lately. Sulphocarbolates, 333. 

Dropsy : 
Digitalis, 427, 428, one of the foremost remedies, 
especially in cardiac and renal dropsy, less so in 
dropsy of cavities. Squill, 676, has effects very 
alike digitalis, and is prescribed under the same 
conditions. Juniper, 672, Pipsissewa, 674, 
Parsley, 677, Scoparius, 674, and other urino- 
genitals having diuretic properties, of great 
value in cardiac dropsy; must be used cau- 
tiously in renal dropsy. Copaiba, 667, espe- 
cially the resin, has given good results in ascites. 
Potassa Salts, 195, especially bitartrate and 
acetate largely diluted, highly useful in renal 
dropsy. Iron, 133, especially tincture of the 
chloride, alone or in Basham's mixture, as a 
diuretic and to correct anaemia. Pilocarpus 
(Jaborandi), 572, very valuable in renal dropsy 
when secretion of urine is much reduced or 
suppressed. Hydragogue Cathartics, 648, 
especially indicated in ascites. Saline Purga- 
tives, 634, in general dropsy. Dry Diet, 42. 
Milk- Cure, 46. 

Dysentery, Acute : 
Aliment, 42, 46, 52, of first consequence. Saline 
Purgatives, 634, especially Epsom salts in acute 
dysentery, with bloody discharges and high 
fever. Ipecacuanha, 627, a remedy of highest 
value in acute, epidemic, and puerperal ; must 
be administered in large doses; milk a good 
vehicle. Nitrate of Silver, 264, Sulphate of 
Copper, 270, Sulphate of Zinc, 280, are excel- 
lent astringents after the more acute symptoms. 
Acetate of Lead, 276, may be used at any pe- 



CLINICAL IXDEX. 



721 



riod, but better after action of salines, in acute 
disease. Opium, 527, combined with some of 
the astringents, but given after the action of 
salines in the acute disease. Turpentine, 662, 
in epidemic dysentery of low type. Ergot, 414, 
has been used with success in acute. 

Dysentery, Chronic: 
Aliment, 42, 46, 52, Grape-Cure, 42, Arsenic, 
151 ; Fowler's solution with opium. Iron, 129, 
pernitrate, a powerful astringent. Tannic 
Acid, 300, with milk-diet, and the vegetable 
astringents. Silver, copper, and zinc salts (as 
above), with opium. Nux Vomica, 398. Er- 
got, 414. Ipecac, 627, etc. 

Dysmenorrhea : 
Aconite, 601, and Pulsatilla, 60S, for the con- 
gestive form especially succeeding to suppres- 
sion. Ergot, 416, under the same conditions 
as the two preceding ; also, Cimicifuga, 433. 
Camphor, 457, Gelsemium, 563, and Apiol, 
677, are useful in the neuralgic form. Amyl 
Nitrite, 593, affords relief quickly. Chloro- 
form. 493, Atropine, 441, Chloral. 514, Canna- 
bis Indica, 465, Morphine, 532, all give relief 
in painful menstruation. Electricity, 3S7, gal- 
vanism during the interval is highly useful. 
Iron. 133, in anaemic cases. 

Dyspepsia : 
Diet, 42. 46. 52, the most important, especially 
the milk-cure. Pepsin, 90, and Pancreatin, 
90, assist digestion in atonic dyspepsia. Min- 
eral Acids, 97, muriatic acid after meals, with 
or without pepsin, in atonic dyspepsia. In an 
excess of acid of stomach-juice, the mineral acid 
before meals. In excess of uric acid as well as 
of stomach acid, nitric acid before meals. Alka- 
lies, 193. to relieve excess of acid: given before 
meals, alkalies favor the production of acid gas- 
tric juice; after meals, neutralize acid. Alka- 
line Mineral-Waters, 204, as well as alkalies, 
are highly useful in dyspepsia of obese subjects. 
Bitters, Simple, 159, especially gentian and 
calumba, stimulate digestion ; may be given 
with acids or alkalies. Arsenic, 150, drop doses 
of Fowler's solution relieve irritative dyspep- 
sia. Silver, 263, oxide especially, is very use- 
ful. Nux Vomica, 397, is an excellent stomach- 
ic tonic, and removes various nervous symp- 
toms. Hydrastis, 166. Eucalyptus, 163, Wild 
Cherry, 161, Hop, 537, are useful stomachic 
tonics. 

Ear- Ache : 

Opium, 533, in the form of morphine solution, 
which is usefully combined with atropine. Hop- 
poultice, 538. 

Eclampsia : 

Transfusion, 19, has been successfully employed 
in ursemic convulsions. Bloodletting, 692, 
when there is much cerebral congestion. Mor- 
phine, 531, hypodermatically in ursemic. Chlo- 
roform, 503, by inhalation. Chloral, 513. Bro- 
mide of Potassium, 545. Pilocarpine, 571, in 
ursemic or puerperal convulsions. Veratrum 
Viride, 606, in puerperal. 

Ecthyma : 

Cod-liter Oil, 108, both internally and locally. 
46 



Quinine, 134, usually effects a care, but must 
be given in full doses. 

Eczema : 

Carbolic Acid, 330, internally and externally. 
Salicylic Acid, 345, applied locally. Boracic 
Acid, 352, one of the most efficient remedies, 
locally. Lead, 277, liquor plumbi subacetatis 
with glycerin, a good application when there is 
abundant secretion. Bismuth, 144, in powder 
freely to the eruption. Tannin, 303, in pow- 
der dusted over, or as glycerite of tannin. Cop- 
per Sulphate, 271, Zinc Sulphate, 2S2, Silver 
Nitrate, 266, are useful astringent applications. 
Mercury, 257, the brown citrine ointment to 
eczema of eyelids. Belladonna, 442, or atro- 
pine, internally, is beneficial in the acute cases. 
Arsenic, 153, is curative in chronic cases. Elec- 
tricity, 387, by central galvanization has done 
great good in chronic cases. 

Emphysema : 
Compressed Air, 81, affords much relief, some- 
times permanent. Oxygen, 319, for the parox- 
ysms of difficult breathing. Grindelia, 609, 
gives great relief to the oppression. Arsenic, 
152, long continued, improves the nutrition of 
the lungs. Cod-liver Oil, 107, improves the 
condition ; Hypophosphites, 122, also. Strych- 
nine, 401, is a valuable respiratory stimulant. 

Empyema : 
Iodine, 237, a solution of iodine and iodide of po- 
tassium to wash out the cavity and prevent re- 
formation of pus. Carbolic Acid, 330, and 
carbolate of iodine, 330, to correct fetor. 

Endocarditis : 

Quinine, 177, to check inflammation. Chloral, 
512, Salicylic Acid, 342, is useful in the rheu- 
matic form of the disease. Moiphine, 528, as a 
remedy in serous inflammations. Potash Salts, 
193, liquefy exudation. 

Endometritio : 

Carbolic Acid, 330, undiluted on cotton-wrapped 
probe. Iodo-tannin, 238, and iodoform and 
tannin locally. Chromic Acid, 695, applied in 
solution to interior of cavity. Nitric Acid 
(fuming), 102, highly efficient. 

Enter algia : 
Milk- Cure, 46, stops the troubles of digestion 
which give rise to the pain. Arsenic, 150, is 
remarkably beneficial in the more strictly neu- 
ralgic cases. Belladonna. 438, is useful as an 
anodyne, atropine especially. Prussia Acid, 
5S3, official solution, gives relief promptly, or 
fails entirely. Galvanization, 3>6, centric, per- 
sistently applied, is curative sometimes. 

Enteritis. (See Diarrhoea, Dysentery.) 
Diet. 42, 46, 52. must be regulated, an essential 
point in treatment. Arsenic, 150, with opium, 
usually highly effective as a remedy. Copper 
Sulphate, 270, Lead Acetate, 276, and the 
other mineral astringents, with opium, are cu- 
rati ve. 

Epilepsy : 

Amyl Nitrite. 592, inhaled when aura is felt may 

prevent seizure; Nitro-glycerin, 596. also, if 

there be more time. Bromide of Potassium, 

545, is the most useful remedy, but is adapted 



722 



CLINICAL INDEX. 



to the cases occurring in the daytime, to the 
grand mal, and to reflex epilepsy, and to the 
condition of cerehral hyperaeinia rather than 
anaemia. Chloral, 514, is the most suitable 
remedy for the nocturnal variety. Cannabis 
Indica, 465, Atropine, 440, Strychnine, 400, 
Picrotoxin, 407, are suitable for petit mal, for 
nocturnal variety, for cases characterized by 
anaemia and depression, and must be faithfully 
persisted in for a long time. The last-named 
seems most promising. Silver Nitrate, 264, 
formerly much prescribed, and not without 
utility, but the danger of staining is great. 
Salts of Copper, 271, Zinc Oxide, 281, so called, 
nervine tonics have been beneficial, but are not 
curative. Iron, 132, especially the bromide, 
with potassium bromide to prevent the anae- 
mia and depression caused by the latter. 
Epistaxis : 
Ergot, 415, Barium Chloride, 217, Digitalis, 424, 
Ipecacuanha, 627, restrain haemorrhage by act- 
ing on the vessels. Turpentine, 663, in oozing 
from relaxation. Locally Tannin, 302, in solu- 
tion injected. Iron, 183, subsulphate in spray 
or solution injected. Alum, 294, powder insuf- 
flated, or solution injected. Transfusion, 19, 
when a fatal result is threatened from loss of 
blood. 
Epithelioma : 

Coptis, 159, infusion or decoction locally, espe- 
cially in epithelioma of the tongue. Potassa 
Chlorate, 201, recently ascertained to be very 
effectual applied in powder. Zinc Cldoride, 
and Sulphate dried, 282, useful escharotics. 
Carbolic Acid, 330, injected beneath tumor. 
Salicylic Acid, 345, and Boracic Acid, 352. 
Erysipelas : 
Aconite, 601, in the idiopathic variety, when 
there is much fever. Belladonna, 440, a very 
beneficial remedy, combined with aconite when 
there is sthenic reaction. Quinine, 177, in full 
doses in the more severe cases, to sustain the 
powers of life and prevent cerebral embolism. 
Salicylic Acid and Salicylates, 841, Benzoate 
of Sodium,, 355, and Eesorcin, 349, to prevent 
systemic infection in traumatic variety. Car- 
bonate of Ammonia, 214, when cardiac depres- 
sion exists. Iron, 131, especially tincture of 
the chloride in large doses. Locally Argenti 
Mtras, 266, according to HigginbothanVs 
method, Carbolic Acid, 328. and the antiseptics 
generally to the inflamed area. Oil inunctions 
are very grateful in simple erysipelas, 106. 
Erythema : 

Quinine, 184, is very effective in erythema no- 
dosum; Belladonna in simple E. Zinc, 2S2, 
Alum, 290, and Lead, 277, are suitable local ap- 
plications, as lotions. Bismuth dusted over the 
surface allays irritation. When the disease is 
reflex from gastro-intestinal disorder, Nitric, 
101, and Muriatic Acids, 101, are beneficial. 
Exophthalmic Goitre : 
Iron, 130, and Chalybeate Waters, 141, for the 
anaemia. Digitalis, 428, Barium, 217, Ergot, 
416, and in some cases Belladonna, 439, raise 
the arterial tension and slow the heart. Gal- 



vanism, 386, in uncomplicated cases, is decid- 
edly curative. 
Favtjs : 

Cod-liver Oil, 108, locally, and in case of debility, 
by the stomach. Carbolic Acid, 330, an effi- 
cient parasiticide. Myrtol, 357, Eesorcin, 349, 
Salicylic Acid, 345, and Boracic Acid, 352, 
are efficient local applications. 
Feet, Fetor of : 
Potassa Permanganate, 138, in solution, will 
remove fetor temporarily. Bicarbonate of 
Soda, 200, a saturated solution, is serviceable. 
Salicylic Acid, 345, in powder freely dusted 
over the feet and stockings, is very effective. 
Felon : 
Nitrate of Silver, 265, a strong solution m nitric 
ether applied over the part may abort the affec- 
tion, if at the beginning. Nitrate of Lead,111 . 
Fever : 
Aconite, 600, highly useful in simple inflamma- 
tion, and in the eruptive fevers. Aliment, 46, 
49, 53, must be regulated. Alcohol, All, does 
good when the temperature declines, the pulse 
falls, the skin perspires, and the tongue grows ' 
moist. Baths, Cold, 66, 67, certain method of 
reducing body-heat, and especially valuable in 
typhoid and pneumonia. Digitalis, 425, is in- 
dicated in inflammatory fever and in the erup- 
tive fevers during the first stage, and as an aid 
to quinine when employed as an antipyretic. 
Quinine, 179, occupies the first position as an 
antipyretic, and is more generally applicable 
than any other. Chloral, 512, reduces fever, 
and is highly useful when high febrile excite- 
ment coincides with delirium and wakefulness. 
Salicylic Acid, 841, Resorcin, 349, Benzoate 
of Sodium, 355, are antipyretic and antiseptic. 
Oalomel, 253, and compound solution of Iodine, 
234, the former administered during the first 
week, and the latter during the whole course of 
typhoid fever, affect the course and duration 
favorably; "the specific treatment 1 ' of the 
Germans. Carbolic Acid, 328, and Carbolate 
of Iodine, 234, have good effects in typhoid. 
Turpentine, 663, in typhoid, puerperal, and 
yellow fever, when there is much vaso-motor 
depression, haemorrhage, etc. 
Fissure of the Anus : 
Hydrastis, 167, the fluid extract applied undi- 
luted. Iodoform, 236, dusted well over the 
fissure, and lodo-tannin, 237, applied in the 
same way. 
Fissure 07 Nipples: 
Iron, 135, liquor ferri subsulph., and glycerin ap- 
plied with a brush. Tannin, 302, in powder or 
the glycerite. Tincture of Benzoin, 354, with 
glycerin. Brandy, 479, with or without gly- 
cerin. Collodion, 698, or flexile collodion, ap- 
plied to close fissure. Nitrate of Lead, 277, 
with simple ointment or glycerin, is the most 
efficient application. 
Flatulence : 

Calumba, 160, with aromatics. Camphor, 456, 
will often give prompt relief. Chloroform, 492, 
especially the spirit. AsafozUda, 459, Vale- 
rian, 462, and Spirit of Ether, 4S9, compound, 



CLINICAL INDEX. 



r23 



are adapted to nervous and hypochondriacal 
cases. Turpentine, 662, is indicated in the 
flatulence of fevers, peritonitis, etc' Nux 
Vomica. 393, Belladonna, 437, Physostigma, 
576, and probably Muscarine, 615, give relief 
to those cases of flatulence dependent on pare- 
sis of the muscular layer of the bowel. Diet 
is of the highest importance, in cases arising 
from intestinal indigestion. 

Freckles : 
Alkalies, 200, in form of a lotion composed of 
potassa carbonate and chloride of soda. Bibo- 
rate of Soda, 200, a saturated solution, is a safe 
and often successful lotion. 

Gall-Stones. (See Calculi, Biliaey.) 

Gangeene : 
Bromine, 322, one of the best escharotics in hos- 
pital gangrene to arrest morbid action. Chlo- 
rine, 320. Chromic Acid, 695, is a highly 
efficient caustic, and penetrates deeply with 
little pain, comparatively. Chloride of Zinc, 
2S1, powerful, but painful. Potassa Fusa, 201, 
an active escharotic. Nitric Acid, 96, 101, 
next to bromine, is the most useful caustic to 
arrest the destruction of parts, external, by 
gangrene. Salicylic Acid. 345, Resorcin, 349, 
Myrtol, 357, and Carbolic Acid, 330, are use- 
ful to destroy fetor, and change the character 
of the morbid action. Turpentine, 665, inter- 
nally and by vapor inhaled. Eucalyptol, 164, 
Camphor, 457, are highly useful in gangrene of 
the lungs to prevent extension and to destroy 
fetor. 

Gastbaxgia : 
Aqua-puncture, 691, gives great relief. Alum, 
294, affords relief in gastralgia with pyrosis. 
Arsenic, 150, drop-doses of Fowler's solution 
are remarkably beneficial. Ether, 489, some 
drops of sulphuric ether or Hoffmann's ano- 
dyne. Atropine, 437, by the stomach or sub- 
cutaneously. Bismuth, 143, acts well, but is 
more efficient if given with aromatic powder 
• and a little morphine. Chloroform, 492, a few 
drops, acts promptly. Oxides of Zinc, 2S0, 
Manganese. 137. and Silver, 262, have curative 
effects, but do not act quickly. Hydrocyanic 
Acid, 5S8, and especially Nitro-glycerin, 596, 
allay the pain speedily. In cases having a dis- 
tinct periodicity, Quinine and Salicylic Acid, 
340, have acted well, and Resorcin, 349, will 
probably be found beneficial. Nux Vomica. 
397, may remove the morbid state on which the 
pain depends. Morphine, 526, subcutaneous- 
ly, alone or combined with atropine, stops the 
pain at once. Galvanism, 886. the pneumogas- 
tric and sympathetic acted on, has been suc- 
cessful. Diet, 46, 51, is of the utmost conse- 
quence. 

Gasteic Catabeh : 
Aliment, 46, 51, especially the milk-cure. Ar- 
senic, 150, is the most important remedy; next 
are Oxides of Silver, 263, Manganese, 137, and 
Zinc, 2S0, Bismuth, 143, Alum, 295, and Ace- 
tate of Lead, 275. The Bitters, 156, especially 
Calumba, 159, Mix- Vomica Tincture, 398, 
Cinchona Infusion or Quinine, 176, Eucahjp- 



his, 163, and Hydrastis, 166, are beneficial, if 
not continued too long. Resorcin, 349. 

Gastric Ulcer : 
Milk-Cure, 46. Rectal Alimentation, 56. Nu- 
trient Enemata, 55. Acetate of lead, 275, 
sedative and arrests haemorrhage. Bismuth, 
143, allays pain and arrests vomiting. Arsenic, 
150 ; Fowler's solution in drop-doses also less- 
ens pain and vomiting remarkably. Silver Ox- 
ide and Nitrate, 263, promote cicatrization and 
relieve pain. Morphine and Atropine, 526, 437, 
arrest pain and vomiting, even in very minute 
quantity. 

Gastritis, Acute : 
Ice, 71, Hydrocyanic Acid, 583, Morphine, 526, 
subcutaneously or endermically. Rectal Ali- 
mentation, 56. * 

Gastritis, Chronic. (The same as for Gastric 
Cataeeh.) 

Glands, Lymphatic, Affections of. 

Carbolic Acid, 329, properly diluted, injected 
into the substance of glands. Iodides of Iron 
and Manganese, 132, 137, internally, and tinc- 
ture of iodine injected into the substance of 
glands, 236. Sulphides, 223, are said to mature 
or abort suppuration in glands. Chloride of 
Calcium, 199, is highly useful in strumous in- 
flammation and suppuration. Pilocarpus, 570, 
has a curative action in acute affections of pa- 
rotid and submaxillary glands. Conium, 552, 
locally and systemically, has long been regarded 
as discutient. Mercury, 250, especially bichlo- 
ride, in acute inflammatory diseases of tonsils, 
parotid and submaxillary glands. Iodide of 
Lead, 277, as an ointment externally. Oint- 
ment of the Red Iodide of Mercury, 235, has 
remarkable effects in goitre, enlarged spleen, 
etc. 

Gleet : 
Iron, 134, 135, tinct. ferri chloridi, in anaemic sub- 
jects. Turpentine, 665, is beneficial when the 
local condition is one of relaxation. Juniper, 
672, Cantliarides Tinct.. 6S2, are useful under 
same circumstances. Blisters. 6S9, to the peri- 
na?um are very beneficial. 

Goitre : 
Iodine, 232, both internally and locally, effective 
in the case of simple hypertrophy. Ointment 
of the Red Iodide of Mercury. 235, exception- 
ally useful in same state. Injections of Tinc- 
ture of Iodine, 236, very effective in cystic de- 
generation. Electrolysis, 3SS. has succeeded in 
simple hypertrophy and cystic state of gland. 

GONOERH03A : 

Internal Eemedies.— Copaiba, 667, Cubeba, 669, 
Buchu, 673, and other urino-genital remedies, 
more useful after acute symptoms. Colchicum, 
303, Saline Laxatives, 635, Aconite, 599, and 
Veratrum Viride, 605, during the first acute 
symptoms. Turpentine. 665, and Cantharides 
Tincture, 6>2, for the chronic stage. 

Injections.— Bism uth. 144, with or without Fl. 
Ex. of Hydrastis, 167, is one of the best. Zinc 
Sulphate. 282, a very weak solution, often re- 
peated, can be used at once, or chloride or sul- 
phate of zinc and Acetate of Lead, 277, in 



724 



CLINICAL INDEX. 



combination. After the acute symptoms, 
stronger solutions of above and Nitrate of Sil- 
ver, 267, Sulphate of Copper, 271, Subsulphate 
of Iron, 135, Cadmium Sulphate, 288, Alum, 
295, and Tannin, 303. 

Gout: 
Aliment, 53, of first importance. Alkalies, 193, 
and Alkaline Mineral- Waters, 206, 208, espe- 
cially potash and lithium salts. Manganese 
Salts, 137, very serviceable in chronic gouty 
affections. Salicylic Acid, 344, and salicylates 
very effective in the acute form. Guaiac, 310, 
after acute symptoms. Colchicum, 305, espe- 
cially colchicia, the most celebrated remedy for 
the paroxysms. Arnica, 565. Arsenic, 154. 
Sulphurous Waters, 227. Sulphur-Baths, 227. 

Gums, Affections of : 
Alum, 295, for spongy and bleeding. Tannin, 
302, especially Glycerite, 303, for same condi- 
tion. Carbolic Acid, 330, and Carbolate of 
Iodine, 330, when fetor is present. Benzoin 
Tincture, 354, with or without glycerin. Be- 
sorcin, 349. 

HEMATEMESIS : 

Alum, 291, especially in passive. Acetate of 
Lead, 275, may be used in all conditions. Iron, 
128, as Monsel's solution, one of the most effec- 
tive applications. Tannin, 299, and the vege- 
table astringents, especially Hamamelis, 300, 
Bhatany, 300, and Logwood, 300, Turpentine, 
663, in weak and relaxed state of vessels. Er- 
gotin, 415, subcutaneously. 
Hematuria : 

Ergot, 416, by the stomach or subcutaneously; 
may be combined with rhatany, ipecacuanha, or 
other astringents. Gallic Acid, 299, 300, one 
of the most useful remedies. Bhatany, 299, 
owes its latility to the presence of tannic and 
gallic acids. Quinine, 183, is highly effective 
in the intermittent trouble : Turpentine, 663, 
in the hemorrhagic state or passive. 
Hemoptysis : 

Ergot, 415, with ipecac and a little opium by the 
stomach ; ergotin subcutaneously. Gallic Acid 
and ergot, 301, by the stomach. Ipecacuanha, 
627. Digitalis, 424. Tinct. of Verat. Viride, 
605. Barium Chloride, 217. Iron, 128, sub- 
sulphate solution in spray, a highly effective 
application. Acetate of Lead, 276, with opium, 
frequently prescribed, but not so effective as 
the previously named. 

HEMORRHAGE AND HEMORRHAGIC DIATHESIS : 

Arterial Sedatives.— Digitalis, 424, Verat. Vi- 
ride, 605, Aconite, 600, Acetate of Lead, 276, 
Barium Chloride, 217, Venesection, 692, Ipe- 
cac, 627, and Ergot, 415, act by slowing the 
heart and diminishing the caliber of the vessels, 
and are therefore adapted to active haemorrhage. 
Turpentine, 663, Ammonia, 213, by stomach 
and by intravenous injection, and Alcohol, 477. 
484, relieve, by increasing the contractile energy 
of the vessels, and are therefore indicated in 
passive haemorrhage. To these must be added 
Transfusion, 19, when death is imminent from 
simple loss of blood. Astringents are em- 
ployed locally and systemically, and include 



Alum, 291, Acetate of Lead, 276, Iron, Sub- 
sulphate and Chloride, 128, 133, 135, Sulphuric 
Acid, 100, Tannin, 299, Gallic Acid, 299, and 
the Vegetable Astringents, 300. 

Hemorrhage, Cerebral: 

Venesection or Leeches, 692, when the blood- 
pressure is high and haemorrhage threatened or 
proceeding. Purgatives, 635, under the same 
circumstances. Ergotin, 415, Barium Chlo- 
ride, 217, and arterial sedatives, when collateral 
hyperaemia comes on. 

Hemorrhage, Intestinal: 

Tannic Acid, 299, and vegetable astringents. 
Acetate of Lead, 275. Sulphuric Acid, dilute, 
100. Iron, pernitrate, 128. Turpentine, 663. 
Opium, 528, to quiet intestinal movements. 
Ice, 71, to abdomen. Ergotin, 416, hypoder- 
matically. 

Hemorrhage, Utefine : 
Ergot, 415, fluid extract in full doses. Ipecac, 
627, carried to nausea merely, is highly effective. 
Digitalis, 424, Nux Vomica, 399, Barium 
Chloride, 217, Sulphuric Acid, dilute, 100, 
small doses frequently, and Epsom Salts, 635. 
Cold, 71. Hot Water, 71. Iron, 134; Mon- 
sel's'solution, diluted, injected. 

HAEMORRHOIDS : 

Aloes, 642, in recent haemorrhoids, as after deliv- 
ery, highly useful. Ergot, 410, in dilated hae- 
morrhoidal veins without new tissue, by the 
stomach and topically. Alkaline, 206, Sulphu- 
rous, 227, and purgative Clialybeate Waters, 
141. Salijie Purgatives, 635, notably Epsom 
salts, in bleeding piles. Senna, 638, the con- 
fection especially, Sulphur, 630, and Cream of 
Tartar, 635, to render movements soft and 
easy. The Grape- Cure, 4,2. Alum,2V\. Iron, 
135; MonseFs solution to arrest bleeding. 
Leeches, 693, to inflamed piles. Nitric Acid, 
107, to the mulberry, bleeding pile. Ung. 
Gallce, 303, ointment for haemorrhoids. Car- 
bolic-Acid Injections, 329. 

Hat-Fever : 
Arsenic, 151, internally and in cigarettes. Atro- 
pine, 439, when secretion is profuse. Carbolic 
Acid, 327, by inhalation. Bromine, 321. Qui- 
nine, 1S3, 1S6, is useful at onset in spray, 
locally, and later as a tonic. Iodides, 231, 
carried to iodism, afford great relief ; may be 
combined with arsenic. Grindelia, 609, for 
the asthmatic symptoms. Muscarine, 615, will 
probably prove useful in the asthmatic stage, 
if membrane is dry. Morphine, 533, is prob- 
ably beneficial at any stage, but great danger 
of morphine -habit. Pilocarpine, 571. 

Headache : 
Ammonia, 214, for nervous headache ; especially 
aromatic spirits. Arsenic, 152, for cerebral 
congestion and hemicrania. Bromides, 554, 
for true migraine. Digitaline, 427, in con- 
gestive hemicrania, from venous hyperaemia. 
Et^got, 416, in the headache of miliary aneu- 
risms and in arterial hyperaemia. Galvanism, 
385, applications to cervical sympathetic during 
intervals, persistently, and mild transverse ap- 
plications during seizure. Nitrite of Amyl, 



CLINICAL INDEX. 



725 



592, by inhalation in cases characterized by 
vaso-motor spasm (pallor of face). Also Nitro- 
glycerin, 596, internally under same condi- 
tio!: s. Potassium Cyanide, 590, a solution 
applied on compress to painful region. Phos- 
phate of Soda, 120, in headache due to " bil- 
iousness.'" Picrotoxin, 407, in neuralgic head- 
ache ; also Strychnine, 400. 

Heakt, Diseases of : 
Aconite, 600, Veratrum Viride, 605, and Bro- 
mides, 542, for overaction and simple hyper- 
trophy. Digitalis, 424, in rapid action with 
low tension and valvular lesions. Cimicifuga, 
433. under the same conditions. Ergot, 414, is I 
useful in dilated heart. Amyl Nitrite, 593, iu 
angina pectoris ; also Nitro - glycerin, 596. 
Iron, 133, remarkably beneficial in the irritable 
heart of anaemia. Morphine, 528, hypoder- 
matically in dilated heart and general dropsy 
therefrom. Quinine, 177, in peri- and endo- 
carditis and cardiac weakness. Ammonia, 213, 
inhaled, intravenous, and by the stomach in 
sudden failure. Atropine, 438, a prompt car- 
diac excitant. 

Hemiplegia : 

Galvanism, 392, cautiously applied to the brain ; 
faradism to the muscles, if they waste or de- 
generate. Strychnine, 401, 403, hypodermati- 
cally into the paralyzed muscles, after local 
troubles have ceased. Massage, 85. 

Hepatic Diseases : 
Aconite, 600, in acute inflammation. Alkaline 
Mineral Waters, 205 ; also Sulphurous, 227, 
in portal congestion. Colchicum, 306, is an 
active remedy in congestion of the liver. Nitro- 
Muriatic Acid, 97, and the acid-bath, are use- 
ful in torpor of liver. The resin-bearing pur- 
gatives, Rhubarb, 640, Podophyllum, 646, 
Iris, 647, and Euonymus, 647, are active 
cholagogues. Ipecacuanha, 626, has decided 
effects in stimulating the flow of bile. Chlo- 
ride of Ammonium, 213, and Iodide of Am- 
monium, 230, are useful in catarrh of the bile- 
ducts; also Phosphate of Sodium, 121, Chlo- 
ride of Gold, 259. Mercurials, 251, of doubtful 
propriety. Phosphorus, 122. prevents the for- 
mation or checks the growth of connective 
tissue (sclerosis). 

nEKPES : 

Acetate of Copper, 271, as an ointment ; Calo- 
mel, 257, also as an ointment, and Zinc Oint- 
ment, 2S2, are curative. Belladonna or Atro- 
pine, 442, internally, is useful. Myrtol, 357. 
Galvanism, 387, in cases having a neurotic 
origin, as H. zoster. 

Hoarseness : 
Nitric Acid, 100, is highly effective in hoarseness 
of singers and reflex from stomach troubles. 
Atropine, 432, affords prompt relief usually in 
hysterical aphonia. 

Hydrocele : 
Carbolic Acid, 329, injected into the sac after 
the withdrawal of the fluid. Iodine Tinct- 
ure, 237, injected in the same way. Nitrate 
of Silver, 265, a sufficiently strong solution 
thrown into the sac after fluid is removed. 



Galvano-puncture, 388, also sometimes suc- 
ceeds. 

Hydrophobia : 
Amyl Nitrite, 593, by inhalation, and Nitro- 
glycerin, 596, by the stomach, should be faith- 
fully tried. Curara, 559, has apparently suc- 
ceeded. Morphine, 532, Ether and Chloro- 
form, 501, by inhalation, are palliative. 

Hydrothorax : 
Iodine Injections, 237, to prevent reaccumula- 
tion of fluid. Pilocarpus, 571, to cause ab- 
sorption. Resin of Copaiba, 667, as a diuretic. 
Dry diet, 41 . 

Hypochondria : 
Arsenic, 152, has good effects in the hypochon- 
dria of the aged. Colchicum, 306, with colo- 
cynth, to deplete the portal circulation. Caffeine, 
469, is a serviceable cerebral stimulant in these 
cases. Asafodida, 460, is particularly indicated 
and has great value in cases characterized by 
much flatulence. Opium, 530, small doses of the 
tincture, is a remedy of the first importance. 
Chloride of Gpld, 260, gives excellent results 
in the hypochondria of the aged. 

Hysteria : 
Ammonia, 214, the aromatic spirits, for the hys- 
terical seizure. Asafoetida, 460, Valerian, 
462, Camphor, 457, Eucalyptus, 163, Ether, 
489, are useful remedies to relieve the vapors 
and accompanying symptoms. Phosphates, 
121, Iron, 132, Cuca, 467, Cod-liver Oil, 108, 
Massage, Rest, and Faradism, 85, are the 
remedies to relieve the abnormal mobility of 
the nervous system. 

Impetigo : 

Ghjcerite of Tannin, 303, an excellent applica- 
tion. Acetate of Lead, 277, in solution. Zinc 
Oxide, 282, dusted over or ointment applied. 
Quinine, 184, usually improves. The Mineral 
Acids, 101, in intestinal indigestion. 

Impotence : 
Phosphorus, 117, or Phosphide of Zinc, 117, are 
efficient stimulants. Cannabis Indica, 465, 
also stimulates the function. Nux Vomica, 
399, Sanguinaria, 314, also increase sexual 
activity, but differ in degree. Ergotin, 419, 
subcutaneously about the dorsal vein of the 
penis, or Fluid Extract of Ergot, 416. by the 
stomach, increase the vigor of the erections. 
Arseniate of Iron, 154, acts as a tonic to the 
organs. Chloride of Gold, 259, has also slowly 
acting aphrodisiac effects. 

Incontinence, Nocturnal: 
Belladonna or Atropine, 441. carried to the point 
of inducing some physiological action. Ergot, 
416, in cases due to paresis of the muscular lay- 
er (?). Iron, 134, sirup of the iodide, in weak, 
anaemic subjects. 

Indigestion : 
Aliment, 49, 51, 55. In stomach indigestion, give 
foods digested chiefly in intestine, and, in intes- 
tinal indigestion, food digested chiefly in stom- 
ach. Milk-Cure, 45. Pepsin, 89, Pancreatin, 
90, Ingluvin, 91 — digestive ferments. Mineral 
Acids, 97, and Lactic Acid, 93, in atonic dys- 
pepsia and indigestion. Alkalies, 193, and 



• 



726 



CLINICAL INDEX. 



Alkaline Mineral-Waters, 205, for the indi- 
gestion of the obese, gouty, and rheumatic. 
Sulphurous Acid, 221, for indigestion with 
pasty vomiting, sarcina, etc. Bismuth, 142, 
for painful indigestion and nausea ; also Hydro- 
cyanic Acid, 5S3. Strychnine, 397, or tinct. 
nucis vom., to stimulate organs ; also Ignatia, 
404, and Picrotoxin, 407. Aloes, 641, in indi- 
gestion with torpor of large intestine, and 
pasty motions. Alcohol, 477, an excellent 
stomachic tonic in moderate quantity for the 
indigestion of the old. 

Inflammation : 
Aliment, 49. Water, 66, the methods of hydro- 
therapy, to reduce heat. Alcohol, 4S4, in con- 
dition of systemic and cardiac depression, as an 
antipyretic, etc. Leeches, 693, very useful in cer- 
tain local inflammations superficially situated, 
the systemic condition being sthenic. Aconite, 
599, useful in inflammation of respiratory organs 
and parenchymatous inflammations in general. 
Veratrum Viride, 605, Gelsemium, 563, Ar- 
nica, 566, and especially Ljigitalis, 426, are 
valuable as arterial sedatives to diminish blood- 
supply to inflamed area, and cease to be benefi- 
cial when exudations begin. Belladonna, 438, 
in some catarrhal inflammations is highly use- 
ful. Alkalies, 193, especially the potash salts, 
and ammonia, are very valuable in the exuda- 
tion stage. Saline Cathartics, 631, to lower 
the blood-pressure and to cause excretion of 
products of waste. To the remedies acting on 
the circulation may be added BaHum Chloride, 
217, and Muscarine, 615, and under some cir- 
cumstances Ergot, 416, Quinine, 177, in full 
quantity, especially when combined with opium, 
may abort an incipient inflammation. Opium, 
528, is the most important remedy in serous 
inflammation. Tartar Emetic, 286, affords 
undoubted good results in some forms, notably 
in acute bronchitis. Pilocarpus, 571, has very 
satisfactory results in exudation in the eye, 
pleura, etc. 

Insolation. (Sunstroke.) 

Cold Bath, 69, or douche or wet pack, for the 
state of high fever. Morphine, 531, hypoder- 
matically. Turpentine Enema, 664, as a de- 
rivative. Brandy, 477, and Ammonia, 213, for 
heat-exhaustion. 

Insomnia : 
Alcohol, 478, in the condition of cerebral anasmia, 
or in quantity to induce narcosis. Paralde- 
hyde, 486. Chloral, 512, the most direct and 
generally useful hypnotic. Belladonna, 440, 
in some morbid states with great restlessness 
and delirium; but Hyoscyamine, 409, Hyos- 
cine, 451, and Duboisine, 453, in sufficient quan- 
tity, are more frequently successful, especially 
in the insomnia of mania, puerperal mania, etc. 
Bromide of Potassium, 543, a direct hypnotic, 
but the action is easily prevented. Morphine, 
530, is generally the best sleep-producer in cases 
of pain, in some kinds of mania, and in melan- 
cholia. Ewmulus, 538, a hop-pillow, has in- 
duced sleep; lupuline is more effective. Phos- 
phorus, 117, under some circumstances acts 



well. Galvanization, 3S1, of cervical sympa- 
thetic, causes sleep when circumstances are 
favorable. Water, 69, a tepid or warm bath at 
bed -hour, sometimes succeeds. 

Intermittent Fever: 

Cinchon a, ISO. Quinine is prophylactic; rightly 
used prevents malarial infection, and in proper 
quantity arrests the paroxysms. In severe 
cases, combination with morphine is very effec- 
tive. An attack impending may be arrested by 
Amyl Nitrite, 592, or Nitro-glyeerin, 596, as 
far as the chill ; but Pilocarpine, 571, hypo- 
dermatically, may bring on the sweating stage, 
thus preventing chill and fever. Chloroform, 
493, by inhalation, or by the stomach in a full 
dose, may prevent a chill. Salicin, 334, Sali- 
cylic Acid, 342, and Jtesorcin, 349, especially 
the last named, have decided antiperiodic quali- 
ties only inferior to quinine. Carbolic Acid, 
32S, hypodermatically, seems to be quite effec- 
tive. Apiol, Gil, also has very decided anti- 
periodic qualities. Salicylate of Cinchonidine, 
16S, a recently introduced antiperiodic, is high- 
ly promising. Other substitutes for quinine are 
Nitric Acid, 99, which acts quite well in mild 
cases; Hydrastine, 166, which is very efficient, 
and probably next to quinine, if given in large 
doses; Eucalyptus, 164, more adapted to 
chronic malarial poisoning, and for convales- 
cence after attacks of fever; Oleoresin of Cap- 
sicum, 670, and Nux Vomica, 39S, adjuncts to 
other and more powerful remedies. Kairine, 
Chinoline, and Hydroquinone are recent sub- 
stitutes for quinine, 349. 

Intertrigo : 
Bismuth, 144, dusted over the surface. Zinc- 
Ointment, 282. Glycerite of Tannin, 303. 

Intestinal Catarrh : 
Ammonium Chloride, 213. Bismuth, 143, is 
one of the best remedies. Calomel, 251, in 
minute doses frequently. Nitrate of Silver, 
263, Sulphate of Copper, 270, Acetate of Lead, 
275, Sulphate and Oxide of Zinc, 280, are ex- 
cellent remedies, valuable in the order named. 
The vegetable tonic astringents, Eucalyptus, 
164, Hydrastis, 166, and those containing Tan- 
nic Acid, 300, are also useful. 

Intestinal Parasites : 

Calomel, 252, for the round worm ; also Hydro- 
cyanic Acid, 588. Carbolic Acid, 327, but 
especially Glycerin, 696, for intestinal trichi- 
na. Eemedies against the round worm, San- 
tonin, Spigelia, etc. Papaine, 89, a solvent. 

Intussusception : 
Effervescent Enemata,G54 ; also Irrigation, 654, 
acting mechanically. Tobacco Enema, 5S1, to 
relax spasm. Morphine, 527, hypodermatically 
of first importance. Belladonna, 438. 

Iritis: 
Atropine, 442, to prevent adhesions, and check 
inflammation by emptying vessels of ins. Ese- 
rine, 578, now much employed to break up ad- 
hesions and diminish intra-ocular tension ; also, 
Homotropine, 445. Pilocarpine, 571, to cause 
absorption of exudations and effusions. Mer- 
cury, 253, of great importance, as most cases 



CLINICAL INDEX. 



727 



are specific. Duboisine, 453, is much employed 
as a substitute for atropine. 

Jaundice : 
Aliment, 46, 52, especially the skim-milk cure, 
avoidance of fats, etc. Alkalies, 193, and the 
Alkaline Mineral- Waters, 205. Phosphate of 
Soda, 121, the most useful remedy in catarrh of 
bile-ducts, and in incipient sclerosis. Chloride 
of Ammonium, 213, and the Iodide, 230, are 
beneficial under the same circumstances. Man- 
ganese, 137, has unquestionable cholagogue 
effects, and stimulates the discharge of bile ; is 
adapted to the catarrhal form, and to the jaun- 
dice of gouty subjects. The resm-bearing ca- 
thartics, Rhubarb, Aloes, Podophyllum, Iris, 
and Euonymin, 637, promote the excretion of 
bile. Nitro- Muriatic Acid, 97, internally and 
by bath, has long had good repute in malarial 
jaundice. Mercurials, 251, are of doubtful util- 
ity, but good results seem to be obtained from 
small doses of calomel. 

Joints, Diseases of: 

Carbolic Acid, 329, in solution injected in syno- 
vitis, with reported good results. Galvanism, 
3S6, highly useful in chronic affections. Mas- 
sage, 85, produces remarkable results in stiff- 
ness and deformity of joints from inflammation 
and lack of use. Oleate of Mercury and Mor- 
phine, 257, are of great service in inflammatory 
affections of joints. Nitrate of Silver in Ni- 
trous Ether, 265, an efficient application to 
check inflammation. Blisters, 688, a succes- 
sion of them about the joints, in cases of syno- 
vitis. 

Keratitis : 
Atropine, 442, to check inflammation by causing 
contraction of the vessels. Eserine, 578, lowers 
intraocular tension and relieves pain. Pilocar- 
pine, 571, is of great service in removing exu- 
dation and stopping inflammation. Zinc Sul- 
phate, 2S2, in solution, is an ordinary lotion in 
these cases, and is often prescribed with atro- 
pine. Lead lotions must be used with caution. 

Labor : 
Anaesthetics, 502 ; Chloral,-514, relieves pain and 
stops irregular action. Ergot, 417, is adminis- 
tered to hasten labor under suitable conditions, 
to cause expulsion of placenta, and to arrest 
haemorrhage. Morphine, 532, hypodermatical- 
ly, stops " false pains. 11 

Lactation : 
Belladonna, 444. arrests the secretion of milk: a 
solution of atropine may be applied to the gland. 
Jaborandi, 572, increases secretion of milk. 
Phosphates, especially Phosphate of lime, 
121, are highly useful in the debility of lacta- 
tion. 

Laryngismus Stridulus : 

Quinine, 184, administered in the interval, may 
prevent attacks that recur frequently. Nitro- 
glycerin, 596, will speedily allay the spasm. 
An Anesthetic, 501, will at once stop an attack ; 
a few drops of ether inhaled will usually suf- 
fice. Bromides, 547, will suspend attacks if a 
sufficient quantity is given, and prevent recur- 
rences. Tartar Emetic, 286, a nauseant, will 



stop the spasms, but may induce dangerous 
depression in young children. Subsulphate of 
Mercury, 620, is as effective and safer. Ipecac, 
623, will also arrest attacks. 

Larynx, Diseases of : 
Aconite. 600, in acute catarrh, small dose of the 
tincture often administered. Inhalations, 6, 
of various astringent and anodyne substances : 
also, Insufflation, 5, of the same in powder : 
Tannin, Iodo-Tannin, Iodoform, Iodoform and 
Tannin, Nitrate of Silver, Copper and Zinc 
Salts, Nitrate of Bismuth, Monsel's Iron, Alum, 
Sulphurous Acid, Bromine, Iodine, Oxygen, 
Chlorine, Quinine, Benzoin, Benzoate of Soda, 
Eesorcin, Salicylic Acid, Carbolic Acid, etc. 

Lead-Poisoning : 
Sulphuric Acid, 100, forms the insoluble sul- 
phate; Magnesium Sulphate, 634; for the 
constipation, and for the cachexia, a combina- 
tion of sulphates of quinine and iron, and di- 
lute sulphuric acid. Sulphides, 224. Alum, 
293, is an effective purgative and aDodyne in 
lead-colic ; also, alum whey. Iodides, 234, and 
Bromides, 542. form soluble combinations and 
cause excretion of lead. For the paralysis Gal- 
Tan ism and Faradism, 383, and Strychnine, 
399. 

Lentigo : 

Glycerite of Iodine, 236, locally. Tannin, 303. 

Leucocythemta : 

Oxygen Inhalations, 320, improve the quality of 
the blood. Iron, 130, is of little value in the 
real, but highly useful in the pseudo-disease. 
Chalybeate Springs, 141, are more useful. 
Phosphorus, 116, and Arsenic, 155, are some- 
times beneficial. Digitalis, 428, in young sub- 
jects does good. Ergot, 415, in the splenic form. 
Electricity,3S6, as central galvanization, is very 
beneficial. 

Leucorrho3a : 
Alum, 295, is a cheap and useful injection ; may 
be combined with zinc and borax, in a lotion. 
Bismuth, 144, suspended by mucilage, is an ex- 
cellent injection ; may be advantageously com- 
bined with Fluid Extract of Hydrastis, 167, 
which is one of the best astringent applications. 
Lead, 277, the acetate or Goulard's extract 
properly diluted, is an excellent topical applica- 
tion. Iodo-Tannin, 233, Tannic Acid, 303, 
and Iodoform and Tannin, 243, packed about 
the cervix, is a highly efficient treatment. Car- 
bolic Acid. 330. 333, diluted and used with care, 
is an excellent deodorizer when the discharges 
are foul ; may be combined with the preceding 
lotions. MonsePs Solution, 135. is a good ap- 
plication, but stains clothing. Common Red 
Wine (Ives's seedling), 480, is a good lotion. 

Lepra : 
Nitric and Nitro-Muriatic Acid, 101. for the 
accompanying indigestion. Arsenic, 153, long 
continued, renders important service. Phos- 
phorus, 116, and Phosphates, 122. 

Locomotor Ataxia : 
Phosphorus, 117, useful to relieve pain and retard 
changes. Nitrate of Silver, 265, has done more 
good than any other remedy. Chloride of Gold, 



728 



CLINICAL INDEX. 



260, deserves careful trial. Eyoscya/mine, 450, 
relieves the pains. Electricity, 335, especially- 
static, the faradic hrush, has given great relief. 

Lumbago : 
Acupuncture, 689, sometimes affords immediate 
relief. Aquapuncture, 691, is also very prompt- 
ly curative in some cases, and usually relieves. 
Chloroform, 493, a few drops injected deeply in 
old cases is remarkably beneficial. Cimicifuga, 
433, brings about relief, sometimes remarkably, 
and often fails. Galvanism, 385 — descending 
stabile and labile currents— usually effects a 
cure. Iodides, 234, are curative when disease 
is due to mercurial, plumbic, or other metallic 
poisoning. Morphine, 532, in minute quantity 
injected into the muscles affords prompt relief. 
Salicylic Acid, 344, is an appropriate remedy 
in rheumatismal cases. Hydrotherapy, 70, 76, 
hot douche to back. Emplastra, 684, the vari- 
ous anodyne and healing plasters. Massage, 85. 

Lupus : 

Cod-liter Oil. 103, internally and locally. Iodine, 
236, in strumous and syphilitic cachexia, and 
iodoform, etc, to ulcer. Arsenic, 153, Fowler's 
solution long continued exerts a curative influ- 
ence, and arsenious acid locally. Zinc Sulphate, 
dried, 231, a manageable and efficient caustic. 
Carbolic Acid, 329, undiluted, to sore, and di- 
luted injected beneath. Chromic Acid, 695, a 
very powerful caustic, causing but little pain. 
Potassa Chlorate, 201, in powder, dusted over 
ulcer, has lately been used with great success. 
Galvano-caustic, 389, is an elegant and efficient 
topical agent. 

Lymphoma oe Lymphadenoma : 
Arsenic, 155, persistently used, has good effects. 
Phosphorus. 116, has seemed to cure, but has 
usually failed Iodides of Iron and Manga- 
nese, 137; the sirup has improved the general 
state, and retarded the progress of the dis- 
ease. 

Malabial Cachexia : 

Quinine, ISO, is the most important remedy. Sa- 
licylate of Cinchonidine, 182, Cinchonine and 
its salts, 182, and Chinoidin, 1S2. Alkaloids of 
cinchona, valuable substitutes for quinine. Ben- 
zoate of Sodium. 355. Carbolic Acid, 328. Eu- 
calyptus. 164, is an excellent remedy for the 
convalescence and for the cachexia. The Bit- 
ters, 160, are al.«o highly useful under the same 
conditions. For the anaemia. Iron, 130, is in- 
valuable ; it acts more efficiently in the cachexia 
when combined with Arsenic, 154, which is 
also an important remedy in malarial cachexia. 
Iodide of Iron and Manganese, 137, is also a 
valuable restorative. For the changes in the 
spleen and liver, Compound Solution of Io- 
dine, 234, Iodide of Ammonium, 234, and ex- 
ternally to the splenic region Ointment of the 
Red Iodide of Mercury, 232, are extremely ef- 
fective. 

Mania, Acute : 
Anaesthetics, 501, Paraldehyde, 486, are some- 
times required, but are very dangerous. Chlo- 
ral Hydrate, 513, in appropriate cases, success- 
ful in restoring mind, but requires care. Conine, 



553, without, but especially with, morphine hy- 
podermatically, has sometimes succeeded in 
curing acute mania with great motor excite- 
ment. In the acute cases with great restless- 
less, Gelsemium, 562, and Duboisia, 453, have 
induced quiet and occasionally effected a cure. 
Hyoscyamine, 450, has become an important 
remedy as a calmative and hypnotic. Digi- 
talis, 427, has proved beneficial in paroxysmal 
excitement of general paresis, and in acute 
epileptic mania. Yeratrum Viride, 606, has 
acted well under the same circumstances. Wa- 
ter- Cure, 69, as warm bath and pack, a valu- 
able calmative. 

Mania, Chbontc : 
Ergot, 416, is highly beneficial in chronic mania 
with lucid intervals, and in epileptic mania. 
Bromides, 544, are occasionally useful, but not 
sufficiently active. Morphine, 530, is the most 
important remedy, but Chloral, 513, may be 
better at times. Iron, 132, in cases of an anae- 
mic character, may be very useful. Digitalis., 
427, has good effects in chronic mania, in gen- 
eral paresis, etc. Physostigma, 577, has had 
unexpectedly good results in general paralysis. 
Hyoscyamine, 450. 

Mastitis : 
Belladonna, 445, stops secretion of milk and 
lessens blood-supply; a solution of atropine 
brushed over is the best form. Phytolacca, 
611, appears to arrest the inflammation; the 
tincture and fluid extract are convenient for 
administration. Pilocarpus, 572, should be 
tried in severe cases with much induration. 

Melancholia : 

Opium, 530, small and frequent doses of the 
tincture give best results. Bromides, 544, are 
sometimes highly beneficial, and yet frequently 
fail. Cannabis Indica, 465, is a useful and 
promising remedy. Caffeine, 469, has also done 
good. A rsenic, 152, especially combined with 
minute doses of opium, and in a greater degree 
Aurum, 260, give excellent results. Chloral 
Hydrate, 513, does good as a hypnotic. Col- 
chicum, 307, Colocynth, 645, and other agents 
which unload the portal circulation, render im- 
portant service. 

Meningitis. (See Ceeebeo-spinal Meningitis.) 
For the acute condition before exudation, or dur- 
ing the stage of excitation, Opium, 528, is a 
remedy of the highest importance ; then Ergot, 
416, Gelsemium, 562, Pulsatilla, 608. Aconite, 
601, in about the order mentioned. For Hyper- 
pyrexia, Quinine, 179, Digitalis, 426, Cold 
Baths, 63, Pilocarpine, 571. During the ex- 
udation stage, or stage of depression, Ammonii 
Carbonate, 214, Turpentine, 664, Quinine, 
179, in small doses. 

Menoeehagia : 
Bromide of Potassium, 548, often arrests prompt- 
ly, and is best adapted to cases of ovarian exci- 
tation. Ergot, 415, in the menorrhagia of sub- 
involution. Cannabis Indica, 465, sometimes 
very useful. Digitalis, 424, in cases of mitral 
disease, or when arterial tension is very low. 
Ipecacuanha, 627, is remarkably beneficial in 



CLINICAL INDEX. 



729 



puerperal menorrhagia, and may be advanta- 
geously combined with ergot. Gallic Acid, 
301, sometimes succeeds well. Aloes, 642, is 
indicated in cases dependent on fecal accumu- 
lations, in relaxed habits. 

Mentagba : 

Copper Sulphate, 271, Zinc Sulphate, 2S2, and 
Silver Nitrate, 266, lotions. 

Meecurialismus : 
Iodides, 234, combine with metal and cause its 
excretion by kidneys, chiefly. Bromides, 543, 
it is asserted, have the same effects. Bella- 
donna, 437, is the best remedy for the ptyalism. 
Tannin, 302, Bed Wines, 479, and Brandy- 
and-water are efficient mouth-washes. Qui- 
nine, 177, and the Mineral Acids, 76, for the 
systemic depression. Hyoscyamine, 450, is a 
good remedy for the mercurial trembling. 

Metritis : 

Water, 71, hot vaginal douche has good effects. 
Carbolic Acid, 330, undiluted or diluted, ap- 
plied on cotton-wrapped probe to the linins of 
the uterine cavity. Nitric Acid, 102, the fum- 
ing acid, is also applied directly to the cervical 
canal. Potassa Fusa, 201, to the uterine neck 
to cure indurations. Ergotin, 416, persistently 
used, has great value in chronic interstitial me- 
tritis. Aurum, 259, chloride, very effective in 
chronic induration of the uterus. Nitrate of 
Silver, pure and in solution, 266, is much em- 
ployed, topically, in metritis. Iodine, 23S, Io- 
doform, 236, and various solutions, are freely 
used. Leeches, 694, to the cervix, give good 
results. Saline laxatives, 633, and Saline 
Mineral- Waters, 205, are useful in plethoric 
subjects. 

Migraine : 
Ammonium Chloride, 214, a full dose usually 
cuts short an attack. Cannabis Indica, 465, 
often succeeds. Guarana, 469, Caffeine, Cuca, 
467, will usually arrest a seizure. Ergot, 415, 
cures the congestive form, and Amyl Nitrite, 
593, or Nitro-glycerin, 596, the anaamic. Bel- 
ladonna, 440, relieves those cases accompanied 
by vaso-motor spasm, and .Digitalis, 427, those 
with low tension of the vessels and weak heart, 
or those dependent on a mitral lesion. Bro- 
mide of Potassium, 544, if sufficient doses are 
given, will arrest impending attacks. When 
reflex from stomach disorder, an emetic of 
Ipecac, 625. will stop : if a symptom of intesti- 
nal indigestion, Phosphate of Soda, 120. Diet. 
52, is of the first consequence in the cases of 
stomach origin. 

Myalgia : 
Ammonium Chloride, 214, sometimes affords 
relief. Cimicifuga, 433, often cures, but also 
fails. Electricity, 387, rarely fails to cure; gal- 
vanism and static electricity, and very rapidly 
interrupted faradic, may alike succeed. Coun- 
ter-irritation by Firing, Aquapuncture. 690, 
and Acupuncture, 6S9, will usually relieve. 
When a rheumatic condition is the cause, Sal- 
icylates, 344, will cure; when a mineral poi- 
son, the Iodides, 233. Massage, S5, will usu- 
ally do good. 



Mtelitis : 
When idiopathic, Ergot, 416, Chloride of Bari- 
um, 217, Galvanism, are the most appro- 
priate remedies ; when specific, Mercury, 253, 
or the Iodides, 233. Hydrotherapy, 70, es- 
pecially the tepid rubbing wet pack. Mas- 
sage, S5, to the damaged muscles. After 
acute symptoms, or in chronic cases, Strych- 
nine, 402, Picrotoxin, 407, and similar ex- 
citants are proper. 

Nevi: 

Chromic Acid, 695, readily destroys with little 
pain. Galvano-causty, 390, is a good means 
of removing them. Nitric Acid, 101, is also an 
efficient caustic. Collodion, 693, by mechani- 
cal compression in drying, will sometimes cure 
them. 

Naecosis. (See Antidotes.) 
Ammonia, 213, by inhalation, especially by in- 
travenous injection, in failure of the heart's ac- 
tion. Oxygen inhalations. 319, in chloroform 
narcosis. Faradism, 3S4, to stimulate the re- 
spiratory center by reflex irritation, and the re- 
spiratory muscles directly. Amyl Nitrite, 592, 
by inhalation in cardiac failure. Water, 65, 
the cold douche and cold affusion in cerebral 
narcosis, prussic-acid poisoning, and sunstroke, 
etc. Ether-injections, 490. Heat, 76, in alterna- 
tion with cold. Emetics, Apomorphine, 605, 
Sulphate of Copper, 270, Sulphate of Zinc, 
2S0, etc. 

Neuralgia : 
Aconite, 600, when there is febrile excitement; 
Aconitine, 601, is particularly effective in neu- 
ralgia of the fifth nerve. Alcohol, 478, in suf- 
ficient quantity, is an anodyne, but the alcoholic 
habit is quickly formed. Anaesthetics, 501, 
promptly relieve. Cod-liver Oil, 108, is of 
great value as a nutrient. Chloroform, by 
deep injection, 493, is very effective in old neu- 
ralgia?. Croton- Chi oral, 515, is useful in neu- 
ralgia of the fifth. Morphine, 532. subcutane- 
ously, is the most efficient remedy for the relief 
of pain. Aquapuncture, 690, often remarkably 
beneficial. Belladonna, 441. especially atropine 
subcutaneously, in tic -douloureux and sciatica, 
but full doses must be administered. Arsenic, 
152, benefits by improving the nutrition. Bro- 
mides, 544, are useful in some cases; Cimici- 
fuga, 433, and Gelsemium, 562, do good in 
simple neuralgia of the fifth, and in ovarian neu- 
ralgia. Galvanism, 385, is, next to subcutane- 
ous injection of morphine, the most decidedly 
curative agent. Mat-sage, So, gives much re- 
lief. Copper, Ammoniated, 271, in neuralgia 
of the fifth, has been revived lately. Iron, 
132, is required in anaemia, the usual condition. 
Phosphorus, 117, has proved curative in suit- 
able cases, if pushed. Nitrite of Amyl, 593, 
by inhalation, and Nitro-Glycerin, 596, by the 
stomach in neuralgic dysmenorrhcea. Strych- 
nine, 403, long continued in depressed states of 
the nervous system. Turpentine, 664, in re- 
flex cases. Veratrine, 606, the ointment in su- 
perficial neuralgia. The Antiseptic Oils, 358, 
locally. Chloral and Camphor, 514, with 



730 



CLINICAL INDEX. 



Morphine, applied to the seat of pain. Wet 
Pack, 76, in sciatica, etc. Heat, 76. 

Nymphomania : 
Bromide of Potassium, 548, but large doses are 
requisite. Camphor, 457, and Camphor Mon- 
obromata, must also be given in large doses. 
Tobacco, 582, carried to nausea. 

Obesity : 
Banting System, 40. Alkalies, 1S3, and Alka- 
line Mineral- Water 8, 205. Bromide of Am- 
monium, 546. Potassa Permanganate, 138, 
for the attendant dyspepsia. The Vegetable 
Acids, 219. 

Onychia : 

Chloral, 514, a solution applied locally. Iodo- 
form, 243, in powder or ointment. Nitrate of 
Lead, 277, as powder, in glycerin, or as oint- 
ment. 

Ophthalmia: 
Mercury, 257. Calomel dusted over the conjunc- 
tiva. Tannin, 302, also dusted over the mem- 
brane. Alum, 295, in solution in rose-water. 
Atropine, 442. Eserine, 578, to diminish intra- 
ocular tension. Pilocarpus, 571. Conium, 
553, the alkaloid conine or the succus. in blepha- 
rospasm. Nitrate of Silver, 2C7, Zinc Sul- 
phate, 282, and other mineral astringents. 

Orchitis : 
Ice, 71, in a bag kept applied. Iodine, 230, tinc- 
ture, locally. Mercury, Oleate of, 257, painted 
over. Nitrate of Silve?', 265, in nitric ether, 
painted over. Ammonium Chloride, 215, in 
solution with alcohol. 

Otorbhcsa : 
Lead, 111, lotions of. Silver Nitrate, 267, in 
solution. Tannin, 303, the glycerite, locally. 
Zinc Sulphate, 282. Mercury, 257, the brown 
citrine ointment. Cadmium, 2S8, in solution 
in water. Sulphocarbolates, 333. 

Ovarian Cysts : 
Iodine Injections, 237, of tincture or com- 
pound solution, but adapted only to unilocu- 
lar cysts. Electrolysis, 383, also only in single 
cysts. 

OXALUBIA : 

Nitro-Muriatic Acid, 101, has special utility. 
Nitric Acid. 97, before meals in acid indiges- 
tion and excess of uric acid. 

OziENA : 

Bromine, 321, inhalations of vapor very cautious- 
ly. Carbolic Acid, 330, solution injected, 
spray inhaled. Carbolate of Iodine, 232, 
iodine and carbolic acid vaporized and inhaled. 
Ethyl iodide, 239, by inhalation. Iodoform, 
243, vaporized or solution in ether applied. 
Iodine, 232, inhaled. Bichromate of Potassa, 
201, solution injected. Iodoform, iodo-tannin, 
bismuth, zinc oxide, resorcin, thymol, and simi- 
lar agents applied by Insufflation, 4. 
Pain. (See Neuralgia.) 

Opium, 532, in any form, but especially morphine 
6ubcutaneously, best of all agents for the relief 
of pain. Belladonna, 441, especially atropine 
alone or in combination with morphine. Anes- 
thetics, 501, give immediate relief. Aconite, 600, 
and its alkaloid, aconitine, relieves pain, espe- 



cially of fifth nerve. Cannabis Indica, 465, has 
slight anodyne properties. Chloral, 514, does 
not relieve pain directly, but by stopping spasm, 
unless in dangerous narcotic doses. Croton- 
Chloral, 515, induces anaesthesia of fifth nerve. 
Gelsemium, 562, has feeble anodyne properties; 
Cimicifuga, 433, even less. Galvanism, 385, 
has decided power to relieve pain. In noctur- 
nal pain, Iodides, 233, have remarkable effects. 
Aquapuncture, 690, Acupuncture, 690, Blis- 
ters, 689, and Heat and Cold, 76, relieve pain in 
varying degree. 

Paralysis : 

Cod-liver Oil, 108, favors the restoration of dam- 
aged nerve-elements. Phosphorus, 117, with 
or without oil, as a restorative of nerve-matter. 
Strychnine, 399, 401, an important stimulant, 
but must be used after local troubles in the 
nerve-centers have subsided. Picrotoxin,Wi, 
employed under similar conditions to strych- 
nine. Galvanism and Faradism, 383, are 
first in importance as remedies in the diagnosis 
and treatment of paralysis; especially adapted 
to the " myopathies of spinal origin." Mas- 
sage, 85, an important adjunct to other treat- 
ment. Hyoscyamine, 450, is very useful in 
paralysis agitans. Eserine, 578, is of great 
service in paralysis of the third nerve. In the 
paralysis due to gummata, Iodides, 233, effect 
surprising cures. Ergot, 416, in vesical paraly- 
sis the result of over-distention. Metallothera- 
py, 292. 

Parasites : 
Acetic Acid, 219, in pityriasis versicolor and 
other parasitic skin-diseases. Sulphurous Acid, 
221, destroys sarcina and itch-insect; also Sul- 
pliides, 224. Mercury, 256, the corrosive chlo- 
ride, is very effective in the various parasitic 
skin affections. Salicylic Acid, 345, Carbolic 
Acid, 330, Resorcin, 349, Boracic Acid, 352, 
Benzoates, 355, are useful in same group of af- 
fections. Glycerin destroys trichina. Anthel- 
mintics, 654, contain the most effective para- 
siticides. 

Pemphigus : 
Arsenic, 153, cures the chronic form. Bella- 
donna, 442, for the acute stage. 

Peritonitis : 
Aconite, 599, for the febrile movement. Chloral, 
514, for restlessness and delirium, and to de- 
press the temperature. Opium, 529, is the 
remedy of highest importance, is best adminis- 
tered as morphine hypodermatically. Turpen- 
tine, 663, in puerperal peritonitis with depres- 
sion and tympanitis. Quinine, 177, in full 
doses, Avith or without morphine, is of great 
value before the exudative stage. Ammonia, 
214, Potash Salts, 193, during exudation. For 
external treatment : Rubefacients, 687, Ice- 
bag, 71, to abdomen ; also Heat, 75, and Poul- 
tices, 701. 

Pernicious Fever: 
Amyl Nitrite, 592, by inhalation to prevent rigor. 
Pilocarpus, 571, Quinine, 184, in large quan- 
tity by the stomach or hypodermatically; Mor- 
phine, 530, also, if not contraindicated. Chlo- 



CLINICAL IXDEX. 



731 



roform, 498, in time to prevent the depression 
of the cold stage. 

Perspirations : 
Aromatic Sulphuric Acid, 100, is an ancient 
remedy, but in several respects objectionable. 
Atropine, 442, is one of the most useful reme- 
dies for " night-sweats," and locally applied for 
6weats in various local situations. Picrotoxin, 
407, a minute dose, will stop for several nights 
tbe sweats of consumption. Muscarine, 615, is 
also a serviceable remedy. For sweating of 
the feet, Salicylic Acid, 344, in powder, dust- 
ed over the feet and stockings, is probably the 
best remedy ; may also be used in lotion with 
borax. Permanganate of Potassa, 133, is an 
elegant toilet deodorant in fetid sweating of 
axillae and feet. Oxide of Zinc, 2S0, with ex- 
tract of belladonna in pill, is an ordinary reme- 
dy for night-sweats ; also Gallic Acid, 301. 

Phagedena : 
Bromine, 322, pure, applied with a glass rod, is a 
good escharotic, but not easily managed owing 
to its volatility. Carbolic Acid, 330, superficial 
in its effects, but very useful in mild cases. 
Chlorate of Potassa, 201, in powder a man- 
ageable and efficient remedy. Salicylic Acid, 
845, in powder, to the sloughing and normal 
tissue adjacent. Resorcin, 349, in powder, ap- 
plied in the same way, and Boracic Acid, 352, 
accomplish good results by changing the char- 
acter of the local action. Chloride of Zinc, 
231, and Nitric Acid, 101, are powerfully de- 
structive. Iodoform, 243. Internally : Iodide 
of Iron, 130, Quinine, 1S4, Phosphates, 121, 
and the tonics and restoratives in general. 

Pharyngitis, Follicular: 
In the acute inflammation — Aconite and Bella- 
donna, 433. For local application— Tannin, 
302, Tannin and Iodoform, 243. Iodoform, 
236, 243. in powder or ethereal solution, Alum, 
295, Cubebs, 663, in powder— the powders by 
insufflation. Nitrate of Silver, 265, in solu- 
tion, painted over the surface. Hydrastis, 166, 
the fluid extract, an excellent topical application 
to mucous membrane, inflamed. 

Phlegmon : 

Carbolic Acid, 330. a solution injected as an 
antiseptic. Iodine, 237, the tincture or com- 
pound solution injected after removal of the pus 
to prevent decomposition. Nitrate of Silver, 
265, 263. a solution in nitrous ether painted 
over the inflamed area, may abort the abscess. 
Sulphides, 223, promote formation of matter, 
or extrusion and healing. 

Phosphorus-Poisoning : 
Sulphate of Copper, 110, forms insoluble phos- 
phide and induces active emesis. Turpentine, 
110, the acid or French, or old turpentine, ex- 
posed to or mixed with air, and not rectified 
fresh turpentine. Transfusion, 110, to replace 
damaged blood-corpuscles, has saved life. 

Phthisis : 
Alcohol, 479, an important remedy when it pro- 
motes appetite and digestion, and increases the 
body-weight. Aliment, 43, fresh blood, fats, 
and nitrogenous food. Oxygen, 319. Bensoate 



of Sodium, 355, in spray, has been proposed a 
a specific, and already discredited. Chloride 
of Calcium, 199, has had remarkably good 
effects in some cases. Cod-liver oil, 106, 107, 
is both a valuable food and a remedy; ether 
aids its digestion by increasing the pancreatic 
juice, and quiets the stomach. Mineral Acids, 
100, especially nitro-muriatic in large doses, 
greatly improve the condition of some cases 
and retard the progress of the disease. Car- 
bolic Acid, 327, has been used with great 
advantage by inhalation to destroy the fetor of 
the expectoration, and to act on the local mor- 
bid process; systemically, the acid helps diges- 
tion and stimulates the assimilation. Creosote, 
327, has been used with remarkable success 
recently. Phosphates and Hypophosphites, 
122, Cuca, 470, with or without cod-liver oil, 
have good effects in the more chronic cases. 
Arsenic, 151, improves digestion and the for- 
mation of tissue, and increases the respiratory 
capacity. Strychnine, 401, checks the vomit- 
ing, and is a valuable respiratory stimulant. 
For the night-sweats, Picrotoxin, 407, Atro- 
pine, 442, and sometimes Pilocarpine, 572. 
For the cough, Prunus Virginiana, 162, Bro- 
mides, etc. 

Pityriasis : 
Acetic Acid, 219, will destroy the parasite and 
cure. Borax, 200, is a good application in 
pityriasis of the scalp. Bichloride of Mercury. 
256, in solution, if strong enough, is a certain 
cure for pityriasis versicolor. Oleate of Mer- 
cury, 257, may also succeed. Carbolic Acid, 
333, and Myrtol, 357, will destroy the parasite 
of pityriasis versicolor. The Sulphides, 224 ; 
sulphide of potassa in lime-water is an excellent 
application. 

Pleitkitis : 
Aconite, 599, is a valuable remedy for the febrile 
stage. Bloodletting, 694, by cups or leeches, 
is a good expedient in the initial stage in ple- 
thoric subjects. Blisters, 6S7, are useful at two 
periods : at the onset and as resolution begins. 
Digitalis, 426, is an antiphlogistic, adapted to 
the pre-exudative stage. Iodide of Potassium, 
232, is useful to promote absorption of the exu- 
dation, and tincture of iodine or compound solu- 
tion injected to prevent reaccumulation of fluid. 
Quinine, 177, reduces temperature and checks 
exudation. Morphine, 529, is the most impor- 
tant remedy until exudations occur; quinine 
and morphine in sufficient quantity at the out- 
set may abort. Chloral, 512, is extremely use- 
ful when there are restlessness and delirium. 
Pilocarpus, 571, causes absorption of exuda- 
tion. 

Pneumonia : 
Aconite, 599, Teratrum Viride, 605, and Digi- 
talis, 426, very valuable antipyretics and anti- 
phlogistics for the stage of congestion. Car- 
bonate of Ammonia, 214, Iodide of Ammoni- 
um, 231, for the liquefaction of the exudation. 
Turpentine, 664, a valuable stimulant when 
circulation is feeble, and in gangrene. The 
subcutaneous injection of ether, 490, in ady- 



732 



CLINICAL INDEX. 



namic condition remarkably effective. Quinine, 
177, an important remedy under two condi- 
tions : in large doses during congestion, and in 
small tonic doses as a stimulant when depres- 
sion comes on. Wet Pack, 70, and the cold 
bath, the latter as a remedy for the inflamma- 
tion, according to Jurgensen, the best. Ser- 
pentaria, 161, stimulant expectorant. Mus- 
carine, 615, is a highly promising remedy. 
Morphine, hypodermatically, 529. Blisters, 
6S9, useful at onset, and to promote resolution. 
Copper Sulphate, 271. 

Polyuria : 
Dry diet, 42. of great value. Chloride of Gold, 
259, persistently used, an important remedy. 
Opium, 583, large doses are necessary, and 
therefore extreme danger of forming a habit. 
Ergot, 417, the most beneficial remedy thus far 
known, probably. Pilocarpus, 572, has been 
used with success. 

Poerigo : 
Manganese, 13S, an ointment of the oxide. Ole- 
ate of Mercury, 257, has succeeded. Iodide 
of Lead Ointment, 277, in chronic cases. 

Prostate, Hyperteopiiy of : 
Alkalies, 194, in acid urine, and Benzoate of 
Ammonia, 355, for acid urine. Tincture of 
Iodine, 237, injected through the walls of the 
rectum. Iodoform, 236, by suppository in the 
rectum. Sulphides, 223, are supposed to in- 
duce absorption. Injections of Ergotin, or 
Ergot internally, 416, the most certain means 
of reducing the size oi the organ. 

Prostorrhcea : 

The Urino- Genital Remedies, 660, notably Can- 
tharis, Turpentine, Cubeb, and Copaiba. 
Hydrastis, 167, fluid extract, internally and 
applied locally. Tincture of Chloride of Iron , 
134, when there is much debility. Bromide of 
Potassium, 548, when there are irritability 
and excitement. Ergot, 417, when relaxation 
exists. 

Prurigo: 

Carbolic Acid, 330, locally and also internally. 
Alkaline Warm Baths, 200, at bed-hour. Bel- 
ladonna, 442, internally, sometimes relieves 
remarkably. Potassium Cyanide, 589, in so- 
lution, is effective, but must be used with cau- 
tion. Pilocarpus, 572, does good when skin 
is dry and harsh. Galvanism, 387, has special 
value in cases of neurotic origin. Sulphides, 
224, afford relief in bath or as an ointment. 

Pruritus Vulvae : 

Borax, 200, a saturated solution freely applied; 
also Potassium Bicarbonate, 200, in solution. 
Bichloride of Mercury, 256, in solution of 
sufficient strength. Oleate of Mercury, 257. 
Cyanide of Potassium, 589, as an ointment or 
in solution, if strong enough, relieves greatly, 
but must be used cautiously; also Hydro- 
cyanic Acid, 587, diluted, which may be pre- 
scribed in lotion, with borax. Nitrate of Silver, 
267, a solution painted on the affected parts, 
gives great relief. Sulphites, 267, also as a 
lotion. Oleates of Mercury and Morphine, 
257. 



Psoriasis : 

Cod-liver Oil, 107, of the greatest value both in- 
ternally and locally in cases of strumous origin. 
Arsenic, 153, in chronic cases; may increase 
the disease at first, but persistently used may 
effect a cure. Phosphorus, 118, acts similarly 
to arsenic, and may accomplish better results. 
Locally— Nitrate of Silver, 2C6, Lead— oint- 
ment of the iodide, 277, Coptis, 159. especially 
useful in psoriasis of the tongue, and Sulphur 
Baths, 224. 

Ptyalism : 
Belladonna, 437, very effective in mercurial, and 
of pregnancy. Duboisine may be substituted. 
Locaily— Tannin, 302, Brandy, 479, and the 
Vegetable Astringents, 300. 

Puerperal Convulsions: 
Anaesthetics, 503, especially chloroform ; the re- 
lief is temporary, but time is gained for other 
measures. Chloral, 513, in considerable doses 
is useful. Morphine, 531, hypodermatically, is 
the most valuable agent in the ursemic form, 
but full doses are necessary. Amyl Nitrite, 
592, by inhalation, may do good in cases char- 
acterized by high tension of the vessels. Blood- 
letting, 692, is necessary when there is cerebral 
congestion. Bromides, 545. 

Puerperal Fever : 

Quinine, 177. in large doses, first in importance. 
Opium, 529, when there are wakefulness and 
delirium, especially when local peritonitis ex- 
ists. Salicylic Acid, 341, and the Salicylates, 
Resorcin, 349, and Carbolic Acid, 328, 333, are 
remedies of great value. Turpentine, 663, 
when there is much tympanites or depression. 
Potassa Permanganate, 138, has been used 
with success internally. 

Puerperal Mania: 
Anaesthetics, 501, may be necessary in violent 
cases. Bromides, 544. will quiet, in cases with 
tendency to cerebral congestion. Chloral, 513, 
is a highly serviceable hypnotic, but its persist- 
ent use in anaemic cases is harmful. Duboisine, 
453, and Hyoscyamine, 450, are probably the 
best hypnotics when there are much excite- 
ment and restlessness, as well as wakefulness. 
Chalybeates, 132, and Quinine, 179, are neces- 
sary when there is debility. Morphine, 530, 
under some circumstances is the best hypnotic. 

Puerperal Peritonitis : 

Opium, 529, is the most important remedy, and 
is probably curative. Quinine, 177, in consid- 
erable doses, is next in value ; a combination of 
quinine and morphine. Turpentine, 663, is in- 
dicated in a condition of systemic depression 
and when tympanites is present. Ice, 71, Heat, 
75, to the walls of the abdomen. 

Purpura : 
Digitalis, 424, to overcome the low tension. 
Ergot, 415, slows the heart and raises the ten- 
sion, and thus checks transudations. Sulphuric 
Acid, 100, Gallic Acid, 301, Acetate of Lead, 
276, are astringents of more or less value. Tur- 
pentine, 663, is of great value usually. Iron, 
133, is usually indispensable, especially the tinct- 
ure of the chloride. 



CLINICAL INDEX. 



33 



Pyaemia : 

Qui?iine, ITT, in large doses, Salicylic Acid, 341, 
Resorcin, 349, and the Antiseptics in general, 
are useful in varying degree. Alcohol, 47S, 
and the Malt Liquors, 4S5, have an important 
place. 

Pyelonephritis : 
Eucalyptus, 164, and the TJrino-genital Reme- 
dies, especially Cantharis, 6S1, Turpentine, 
665. Pipsissewa, 673, EHgeron, 672, Gallic 
Acid. 301. 

Remittent Fever : 

Quinine, 179, curative in efficient doses. Resor- 
cin, 349, Salicylic Acid, 341, and Benzoates, 
355, come next. 

Rheumatic Arthritis : 
Lithium, 200, and its salts. Iodides, 234, when 
the disease is due to syphilitic, mercurial, or 
plumbic poisoning. Colchicum, 306, when the 
gouty or rheumatic diathesis underlies the dis- 
ease. Cod-liver Oil, 107, internally and locally, 
is adapted to all forms, and one of the best of 
remedies. Arsenic, 154, is beneficial in cases of 
simple character. 

Rheumatism, Acute : 
Aconite, 600, tincture of the root, for the fever, 
Water, 65, 67, cold baths for the condition of 
hyperpyrexia. Arnica, 565, a remedy for sub- 
acute cases. Bromide of Ammonium, 542, 
a remedy advised by Da Costa. Bromide of 
Lithium, 200, one of the best of the lithia salts. 
Trimethylamine. 566, of doubtful value. Sal- 
icin, 334, Salicylic Acid. 342, and the Sali- 
cylates, Benzoates, etc., 355, now much em- 
ployed in the treatment of acute rheumatism. 
Alkalies, 193, a plan of treatment once very 
popular and still pursued. Iron, 131, tincture 
of the chloride in full doses a valuable remedy 
in weak subjects. Blisters, 639, a succession 
of, around the affected joints, give relief and 
shorten the disease. Mineral Acids, 100, have 
been warmly advocated. Lemon -juice, 219, 
an adjunct to more effective remedies, especial- 
ly to potash salts. 

Rheumatism, Chronic : 
Alkaline Mineral- Waters, 205, Sulphtirotis Wa- 
ters and Baths, 224, 227. The Turkish Bath, 
76, Cod-liver Oil, 107, a very important remedy 
Aliment, 53. Colchicum, 306, in the so-called 
gouty form. Guaiac, 310, is sometimes useful. 
Xanthoxylum, 316, and Cimicifuga, 433, give 
relief in the muscular form, and are less benefi- 
cial when there are joint changes. Iodides, 234, 
produce excellent results in the cases due to 
metallic poisoning. Manganese Sulphate, 137, 
does good in cases of gouty antecedents. Lith- 
ium and its Salts, 200, afford the best results 
in uric-acid diathesis. Salicylic Acid, 344. 

Rickets : 
Aliment, 53, food rich in phosphates, oils, and 
lime. Cod-liver Oil, 106, is a most important 
agent in the process of regeneration. Phos- 
phates, 121, especially the lacto-phosphate of 
lime, and Iron, 132, especially the sirup of the 
iodide. Phosphorus, 117, induces an hyper- 
trophy of bony tissue, and should therefore be 



carefully tried in this disease ; it may be advan- 
tageously given in cod-liver oil. 

Roseola : 
Belladonna, 442, is a suitable remedy when any 
remedy is needed, and Inunctions of Oil, 106, 
allay the cutaneous irritation. 

Rubeola : 
Aconite, 601, and Digitalis, 426, are important 
antipyretics and to relieve the catarrhal pro- 
cess. Carbonate of Ammonia, 214, has the 
greatest value in the catarrhal pneumonia when 
a complication. Quinine, 179, is highly useful 
for the adyr.amia, and in large doses when 
catarrhal pneumonia comes on. Oil Inunc- 
tions, 106, allay irritation of the skin and lessen 
the febrile heat. 

Scabies : 
Sulphur-Baths, 224, Sulphites, 222, and Sul- 
phides, 224, freely and faithfully used, are very 
effective. Carbolic Acid, 330, locally destroys 
the parasite; also, Cajeput-Oil, 358. Corro- 
sive Chloride of Mercury, 256, if strong 
enough, is very effective, but caution is neces- 
sary. Manganese, 13S, an ointment of the 
oxide. Sulphate of Copper, 271, a lotion of, 
may be used successfully. 

Scarlet Fever: 
Aconite, 601, for the fever and local inflamma- 
tions. Digitalis, 426, a very important reme- 
dy as antipyretic and diuretic. Belladonna, 
439, when the eruption is imperfect or bluish, 
the peripheral circulation feeble, and the heart's 
action depressed. Oil Inunctions, 106, dimin- 
ish irritation of the skin and lessen tempera- 
ture. Salicylic Acid, 341, Bensoate of Sodi- 
um, 355. Resorcin, 323. and Carbolic Acid, 
349, antiseptics and antipyretics ; spray to the 
throat, and internally for septic infection. Car- 
bonate of Ammonia, 214, of great value as a 
remedy and as a stimulant to the depressed 
circulation. Quinine, 179, employed under two 
conditions— as antipyretic and tonic. Water, 
68, cold baths and pack, for hyperpyrexia and 
to develop the eruption in the fulminant cases. 
Aqua Chlorinii, 321, is a useful gargle and 
deodorant mouth-wash. Hydrochloric Acid, 
99, internally, and diluted as a lotion for mouth 
and throat. 

Sciatica: 
Atropine, 443, injected subcutancously in the 
neighborhood of the nerve, but the physiologi- 
cal effects must be fully induced. Morphine, 
535, subcutaneously with or without atropine, is 
the most effective treatment. Galvanism, 3S5, 
next to morphine, is the best method of cure. 
Aquapuncture, 690, gives great relief in re- 
cent cases. Acupuncture, 6S9, sometimes re- 
lieves. Chloroform, 493, by deep injection in 
old cases is surprisingly effective, titrate of 
Silver, 263, in solution, injected near to the 
nerve-trunk, is curative in some old cases re- 
sisting other means. Salicylic Acid, 344. 
Iodides, 233, should be used in cases of syphi- 
litic, plumbic, or mercurial cachexia. Turpen- 
tine, 664, has occasionally succeeded; also 
Guaiac, 310. 



734 



CLINICAL INDEX. 



Scleroderma : 
Cod-liver Oil, 108, the most important remedy. 
Phosphates and Hypophosphites, 118, with or 
without cod-liver oil. Phosphorus, 118, in cod- 
liver oil. Galvanism, 387, central galvaniza- 
tion. 

Sclerosis, Spinal : 
Nitrate of Silver, 265, very beneficial. Phos- 
phorus, 117. Galvanism, 384, and Static 
Electricity, 390, Electric Brush, 3S5, Iodides, 
233, when there are specific lesions, and in 
mineral poisoning. Baths, 70, the rubbing wet 
pack. Massage, 95. Oils, 108. 

Scrofula : 

Cod-liver Oil, 106, and Inunctions of Oil, 107. 
Phospliates, 121, to improve the nutrition. 
Iron, 131, and Chalybeate Waters, 141. Io- 
dides, 233, of iron and manganese, especially. 
SUllingia, 311, Sanguinaria, 314, and Sarsa- 
parilla, 309, promote the activity of the vegeta- 
tive functions and improve nutrition. 

Sea-sickness : 
Atropine, 444, subcutaneously, in minute quan- 
tity. Chloroform, 492, a few drops by the 
stomach, frequently. Chloral, 512, probably 
the most effective remedy, but must be given 
before decided nausea sets in. Champagne, 
483, iced in small quantity. Morphine, 526, 
minute doses subcutaneously. Amyl Nitrite, 
593, by inhalation, and Nitro- Glycerin, 596, by 
the stomach, are very useful. Bitters, as Ca- 
lumba, 159, and Tincture of Nux Vomica,^!, 
also sometimes succeed. 

Seborrhea: 

Zinc Oxide, 282, ointment. Potassce liquor, 
200, locally and internally. Glycerin, 696, per- 
sistently continued by the stomach. 

Septicemia : 
Quinine, 177, in large doses, as an antipyretic and 
antiseptic. Salicylic Acid, 341, Resorcin, 349, 
and Benzoates, 354, are employed for the same 
purposes : to keep down the temperature and to 
destroy septic materials. Bromine, 322, Car- 
bolic Acid, 330, and Chlorine, 321, Boracic 
Acid, 352, the Antiseptic Oils, 358, Potassa 
Permanganate, 138, are all used locally to 
destroy sloughing and gangrenous parts, to 
destroy foul odors, and to change the character 
of the surface. Cold Baths, 67, for hyperpy- 
rexia, and Hot Water, 72, for wounds. 

Skin-Diseases : 

Oils and Fats, 106, by inunction and locally. Ar- 
senic. 153, in chronic, scaly skin-diseases. Phos- 
phorus, 118, in place of arsenic and under the 
same conditions. Iodides, 235, when syphi- 
litic, mercurial, plumbic, or other metallic poi- 
sons underlie the local morbid process. Mer- 
cury, 256, 257, of great value in secondary 
syphilitic cutaneous affection. Quinine, 184, 
in ecth3Tna, erythema nodosum, and when de- 
pression of the vital forces exists. Atropine, 
442, is highly useful in certain cutaneous neu- 
roses, and in simple vascular lesions. Pilocar- 
pus. 572, when the skin-secretions are deficient, 
and in alopecia pityroides. Sarsaparilla, 309, 
has long been celebrated in syphilitic and stru- 



mons affections of the skin. Mineral Acids, 
101, in diseases secondary to stomachal and 
intestinal indigestion. Electricity, 3S7, in the 
neuroses of the skin. Locally, the salts of Zinc, 
2S2, and Mercury, 257, Tannic Acid, 303, as 
glycerite or in powder, Carbolic Acid, 330, and 
Iodine, 235, are freely used in various acute 
and chronic affections. Stains of Nitrate of 
Silver, 267, are removed by a solution of cyanide 
of potassium, iodine, and water. 

Spermatorrhea : 
Atropine, 441, Ergot, 416, and Digitalis, 428, 
when the genitals are relaxed, the erections 
feeble because of deficient filling of veins of 
erectile tissue, and the ejaculator muscles pa- 
retic. Cimicifuga, 434, acts similarly, but less 
strongly. Nux Vomica, 399, or strychnine, is 
indicated when a stimulant and tonic are re- 
quired, and Cantharis, 682, when a stimulant 
merely ia needed. Iron, 134, tincture of the 
chloride, when anaemia is a marked feature, and 
Arsenic, 154, when a systemic tonic, as well as 
genital stimulant. Bromide of Potassium, 
548. lupuline, 538, and Camphor, 457, when a 
genital sedative is indicated. Locally, Nitrate 
of Silver, 267, Hydrastis, 167, fluid extract, 
167, Tannin, 303, and vegetable and mineral 
astringents. 

Spina Bifida. : 
Iodine, 237, the tincture injected into the sac. 
Collodio?i, 698, in drying contracts and me- 
chanically compresses. 

Spinal Irritation : 
Electricity, 3S3, is an efficient means of allaying 
the pain and tenderness. Strychnine, 399, one 
of the best tonics for the primary assimilation, 
and stimulant for the depressed nerve-centers. 
Ergot, 416, is required when active hyperaemia 
is present. Bromide of Potassium, 548, does 
good under the same condition. MitchelVs 
Cure, 86, by massage, rest, and faradism, prob- 
ably the best treatment. 

Spleen, Diseases of: 
Eemedies acting on the spleen are, in anaemia. 
Iron, 130, Manganese, 137, and Arsenic, 154; 
in vascular dilatation, Ergot, 415, Qxunine, 182, 
Belladonna, 440, Muscarine, 615, Resorcin, 
849. The most efficient external applications 
are : Cold Affusion, 67, which causes contrac- 
tion of the splenic vessels, Ointment of the Red 
Iodide of Mercury, 235, which, if properly ap- 
plied, causes a rapid reduction of simple hyper- 
trophy, Ointment of Iodide of Lead , 277. 

Sterility : 
Aurum, 259, chloride of gold and sodium, when 
due to chronic interstitial metritis. Phospho- 
rus, 117, when simple functional debility in 
male. 

Stomatitis : 
Alcohol, 479, Brandy-and- Water an excellent 
astringent wash. Bismuth, 142, in powder 
freely applied. Acids, 96, hydrochloric, ap- 
plied directly to ulcers. Eucalyptus, 163, Hy- 
drastis, 165, Rubus, 302, Krameria, 302, and 
other vegetable astringents, the fluid extracts 
being applied pure or variously diluted to the 



CLINICAL INDEX. 



735 



affected parts. Potassium Chlorate, 193, the 
most valuable application, and especially sys- 
temic remedy. 

Strangury : 

Opium, 532, the tincture by enema, or, better, 
morphine subcutaneously. Gelsemium, 562, 
Aconite, 600, Veratrum Viride, 605, and Bro- 
mides. 543, afford relief in varying degree. For 
vesical strangury, Cantharides Tincture, 6S2, 
Turpentine, 665, and various urino-genital 
remedies. 

Stricture : 
Electrolysis, 3S8, cures spasmodic, and, some 
affirm, can cure a permanent stricture. 

Strychnine-Poisoning : 
Emetics or Stomach- Pump ; Tannin, Com- 
pound Solution of Iodine, chemical antidotes, 
Chloral, Chloroform by inhalation, Nicotine, 
subcutaneously, physiological antagonists. 
Rest, Artificial Respiration, and Galvanism 
392. 

Suppuration : 
Alcohol^ 478, a powerful antiseptic and antipy- 
retic, and, externally, a valuable antiseptic 
dressing. Carbolic Acid, 330, and Lister's 
antiseptic method. Quinine, 184, in full doses, 
as a tonic. Sulphides, 223, small doses fre- 
quently mature abscesses, and, under some 
circumstances, abort them ; also, Sulphurous 
Mineral- Waters, 227. Phosphates, 121, and 
Lime Salts, 199, to repair waste by suppura- 
tion. Iodides of Iron and Manganese, 137, 
the sirup of, in the systemic depression caused 
by suppuration. 

Sweating. (Hyperidrosis— see Perspiration.) 
Mineral Acids, 100, especially aromatic sulphuric 
acid. Oxide of Zinc, 280, in night-sweats of 
phthisis, especially with extract of belladonna. 
Gallic Acid, 301, restrains sweating. Atro- 
pine, 442, is a powerful means of arresting per- 
spiration; also, Duboisia, 454, and especially j 
Picrotoxin, 407, Pilocarpus, 570, Resorcin, 
349, and Salicylic Acid, 344, cause sweating, 
and, under some conditions, arrest it. 

STC03IS : 

Carbolic Acid, 330, internally and externally. 
Oleate of Mercury, 257. 

Synovitis : 

Cod-liver Oil, 107, is useful in strumous and 
debilitated constitutions. Nitrate of Silver, 
265, in nitrous ether, painted over the joint. 
Carbolic Acid, 329, solution injected into the 
joint. Oleate of Mercury and Morphine, 257, 
Massage, S5. 

Syphilis : 
Baths, 63, 76, Turkish baths, wet packs, and 
vapor-baths, are very important in promoting 
excretion. Denutrilion, or hunger-cure, 41. 
Cod-liver Oil, 108, useful in chronic cases and 
broken-down constitutions. Mercury, 253, the 
great remedy for constitutional syphilis— by 
stomach, by inunction, by fumigation, or sub- 
cutaneously. Iodides, 233. in constitutional, 
certain forms of secondary and tertiary disease, 
are unrivaled in efficacy. Aurum, 259, comes 
into use after iodides and mercury, to which 



it is greatly inferior. Iron, 131, especially the 
iodide, in sloughing phagedena and in depressed 
states of the system at all stages. Iodoform, 
239, as a local application to chancres. Car- 
bolic Acid, 330, Salicylic Acid, 345, Boracic 
Acid, 352, Benzoin, 354, Chlorate of Potassa, 
201, in powder, are valuable local applications 
to syphilitic sores, abscesses, discharging bu- 
boes, phagedena, etc. Sarsaparilla, 309, Stil- 
lingia, 311, Guaiacum, 310, are important 
adjuncts, vehicles, and remedies for the con- 
stitutional disease, the system being unequal to 
further iodine and mercurial treatment. 

T.ENIJE: 

The various Tainiafuges, 653, Carbolic Acid, 
327, Resorcin, 349, and Salicylic Acid, 340, 
have killed taenia, so that a purgative only was 
necessary. Turpentine, 663, is one of the 
most efficient remedies, although unpleasant in 
the highest degree. Ailanthus, 612, has suc- 
ceeded. Papain, S9, a digestive. 

Tetanus : 
Atropine, 443, injected into the rigid muscles, has 
done good. Strychnine, 399, is alleged to be 
curative in some cases, but doubts are proper. 
Chloral, 514, is certainly a remedy of great 
value. Amyl Nitrite, 593, has been used with 
success; Nitro- Glycerin, 596, should also be 
fairly tried. Gelsemium, 562, has succeeded, 
and is a promising remedy. Curara, 553, val- 
uable, but uncertain. Bromide of Potassium, 
544, seems to be the most successful remedy. 
Physostigma, 576, has also been used with 
advantage in a number of cases, but its real 
value remains to be determined. Hyoscyamine, 
450, or Duboisia, 453, may be used. Nicotine, 
531, has effected a cure, but its use requires 
caution. Anaesthetics, 501, give temporary re- 
lief. Morphine, 536, injected into the tetanized 
muscles, gives great relief. 

Thermic Fever, or Sunstroke : 

Cold Baths, 69, for the hyperpyrexia. Morphine, 
531, subcutaneously, when convulsions occur, 
or the insensibility and high temperature 
persist. Pilocarpine, 571, should be tried. 
Quinine, 178, Resorcin, 349, and other anti- 
pyretics should be administered subcutane- 
ously. 

Thrombosis and Embolism : 
Ammonia, 213, b} r the stomach or by intravenous 
injection, to liquefy the obstructing clot. Er- 
got, 415, Quinine, 179, and Digitalis, 424, for 
the collateral hyperemia and nedema. 

Tic-Douloukeux. (See Neuralgia.) 
Atropine and Morphine, 443, 535, these alkaloids 
in combination subcutaneously give relief. 
Croton-Chloral, 515, has special effects on the 
fifth nerve. Aconitine, 602, has lately been 
given with good results. Galvanism, 3S5, 
and Magnetism, 3S1, relieve the pain. 

Tinea : 
Boracic Acid, 352, is an excellent topical appli- 
cation. Mercury, 256, corrcsive sublimate, as 
an ointment or lotion for tinea tonsurans ; 
oleate of mercury in oleic acid, also, 258. Cop- 
per, 271, an ointment of the carbonate. Car- 



736 



CLINICAL INDEX. 



bolic Acid, 330, applied directly or in glycerin 
to the part affected. Sulphites, 222, in solu- 
tion, also useful. Sulphides, 224, sulphur-baths, 
227, faithfully carried on, are curative. 

Tonsillitis : 
Aconite, 599, the tincture of the root, in cases 
accompanied by fever. Guaiacum, 310, a full 
dose is said to abort an attack. Ice, 64, held 
against the inflamed part, diminishes the con- 
gestion. Mercury. 250, small doses of calo- 
mel or gray powder reduce the inflammation. 
Quinine, 176, in a full dose at the outset may 
abort an attack. Alum, 295, in powder, solu- 
tion, or whey, does good after the acute symp- 
toms. Tincture of Iodine, 2j7, injected, will 
gradually diminish the hypertrophied tonsil. 

Toothache : 
Alum, 295, a solution in nitrous ether is said to 
be effectual. Tannin, 302, dissolved in ether, 
also relieves the pain of a carious tooth. Car- 
bonate of Soda, 201, a saturated solution held 
in the mouth relieves. Opium, 534, or mor- 
phine, a solution of. put in a carious cavity. Oil 
of Cloves, 35S, Carbolic Acid, 330, or Resor- 
cin, 349, put in a cavity stops the pain. Xan- 
thoxylum, 315, is a domestic remedy. 

Torticollis : 

Galvanism, 3S5, to the muscles in a state of 
spasm, and faradic applications to the antago- 
nist muscles in a paretic state. Massage, 85, 
Water, 76, hot douche. 

Tuberculosis : 

Grape-Cure, 42, Whey- Cure, 46, Cod-liver Oil, 
106, Iron, 132, valuable in so far as it improves 
nutrition. Iodide of Iron and Manganese, 
137. Chloride of Calcium, 199, apparently 
exercises a real curative influence. 

Typhlitis : 

Ice, 71, in form of a poultice to the seat of in- 
flammation. Opium, 529, in form of enemata 
of the tincture, or deodorized tincture by the 
stomach, or morphine subcutaneously. which is 
the most effective. leeches, 693, to the in- 
flamed region as soon as tenderness is mani- 
fest, and should not be omitted unless the sub- 
ject is feeble. Purgatives, 634, saline, especial- 
ly Epsom salts, alone admissible in typhlitis 
due to impaction of the caecum, and positively 
contraindicated in the other forms of the disease. 

Typhoid Fever. (See Fever.) 
Aliment, 49, a milk-diet, usually most suitable. 
Acids, Mineral, 99, the muriatic, has been 
much employed as a remedy to diminish fever 
and restrain diarrhoea. Iodine, 234, in the 
form of the compound tincture or solution, is 
a remedy of great value— lessens the violence 
and shortens the duration (German "Specific 
Treatment 1 '). Mercury, 253, calomel in ten- 
grain doses for several days during the first 
week or ten days — " specific treatment " — 
shortens the duration and moderates the vio- 
lence of the disease. Carbolic Acid, 328, and 
creosote have been used with great success ; 
may be administered with iodine advantageous- 
ly. Chlorine, 321. The antipyretic and antisep- 
tic treatment includes, besides the remedies just 



named, Quinine, 178, in large doses, Cold 
BatJis, 66, Salicylic Acid, 340, Resorcin, 346, 
Benzoate of Sodium, 355, Arnica, 564, and 
Digitalis, 425. Nitrate of Silver, 264, Bis- 
muth, 143, Fowler's Solution with Tincture 
of Opium, 155, are employed to restrain diar- 
rhoea. 

Ulcers : 
Nitric Acid, 101, a powerful escharotic, used to 
destroy unhealthy tissues and change the char- 
acter of the surface. I'otassa Chlorate, 201, in 
powder, applied to the surface, is remarkably 
beneficial in cases of unhealthy ulceration, in 
epithelioma, etc. Alum, 295, dried, is a feeble 
escharotic, and destroys unhealthy granula- 
tions. Zinc Sulphate, 281, dried, is a valuable 
caustic, and easily managed ; the chloride of 
zinc is more powerful and penetrating, as well 
as more painful. Potassa Fusa, 201, or the 
milder Vienna paste, diffuses widely and de- 
stroys deeply. Nitrate of Silver, 266, acts 
superficially, and is therefore to be used only 
when the mildest effects are necessary. Sul- 
phate of Copper, 271, is, like silver nitrate, a 
good application to change the character of an 
indolent ulcer, and to form a thin coating under 
which healing may proceed. Iodoform, 236, 
243, in powder, dusted over the ulcer, is a capi- 
tal dressing for syphilitic ulcers, irritable sores, 
and superficial ulcers generally; its odor for 
these purposes may be covered by thymol, 
menthol, or eucalyptol. Carbolic Acid, 330, 
Salicylic Acid, 345, Boracic Acid,Sb2,Resor- 
cin, 349, Thymol, 357, Chlorine, 321, are anti- 
septic, deodorant, and alterative applications, of 
great value in wounds, unhealthy ulceration, 
and sloughing phagedaena Galvanism, 389, a 
galvanic couplet, will heal bed-sores and un- 
healthy ulcers. 

Uremia : 

Water, 65, the vapor-bath, and hot-water pack, to 
excite the skin and promote free diaphoresis. 
Pilocarpus, 571, Muscarme, 615, and Resor- 
cin, 349, active diaphoretics, especially the first 
named, but the state of the heart must be care- 
fully watched— a weak or fatty heart being a 
positive contraindication. Digitalis, 428, the 
infusion, an important means of procuring free 
action of the kidneys. Saline, 633, or Hydra- 
gogue Cathartics, 648, are of great importance 
to secure elimination by the intestinal canal, 
and to relieve the blood-pressure. Colchicum, 
367, is an excellent hydragogue and derivative 
in these cases: is best when combined with 
other purgatives. Morphine, 530, hypodermat- 
ically, in full doses, is of remarkable value in 
uraemic convulsions. 

Cric-Acid Diathesis: 
Aliment, 53, the acid fruits and starchy foods are 
proper, but meats and other nitrogenous mate- 
rials objectionable. When excess of uric acid 
is due to deficient oxidation, Nitric Acid, 101, 
especially is of the greatest value; also muriatic 
and lactic acids. Alkalies, 194, the potash 
salts, particularly after meals ; also the Alka- 
line Waters, 205. Air, 81, Massage, 85. 



CLINICAL INDEX. 



737 



Urine, Incontinence of : 
Belladonna, 441, the most important remedy, 
and the alkaloid Atropine is the best prepara- 
tion, a quantity sufficient to induce its physio- 
logical effects being necessary. Ergot, 416, is 
effective when there is a paralytic sphincter, 
and in the case of diseased prostate. Iodide 
of Iron, 134, the sirup or official pill may be 
used ; it is successful in the case of pale, stru- 
mous, and feeble subjects. Strychnine, 399, 
may succeed when the other remedies fail; 
must be pushed, and is best adapted to cases 
characterized by great nerve mobility or weak- 
ness. When the urine is acid, a proper Diet, 
42, and Alkalies, 194; when alkaline, the 
Bensoate of Ammonia, 354. 

Uterine Colic: 
Aquapuncture, 61 7, gives surprising relief. Mor- 
phine and Atropine, 535, subcutaneously. 
Camphor, 457, Gelsemium, 387, and the ano- 
dynes derivative from alcohol. Chloral, 514, 
Ether, 439, etc. 

Uterus, Firromata of : 
Ergotin, 416, subcutaneously and by stomach 
and rectum. Chloride of Gold, 259, persist- 
ently used. Chloride of Calciwm, 199, also 
taken for a long time. Saline and alterative 
Waters, 209 ; those of St. Catharine's, Canada, 
of Homburg and Kreutznach, etc. Iodine, 
tincture and glycerites, 237, applied topically. 
Electrolysis, 388. 

Uterus, Hypertrophy of ; also, S ub -Involution : ] 
Ergot, 414, 416, fluid extract, and Ergotin, sub- I 
cutaneously, must be persistently administered 
for a long time. Electricity, 386, Galvanism — 
an interrupted current, of great value in cases 
of simple enlargement. Iodoform, 236, and 
Iodo-Tannin, applied directly to the uterus, 
promote absorption. Chloride of Gold, 259, 
long continued in small doses, does much good. 
Phytolacca, 611, Digitalis, 424, and Cimici- 
fuga, 434, are very useful in sub-involution. 
Ipecacuanha, 627, has remarkably good effects 
in recent cases of sub-involution, with menor- 
rhagia or metrorrhagia. 

Uterus, Ulceration of : 
Hydrastis, 167, the fluid extract undiluted, freely 
applied, is a valuable application in cervicitis, 
endocervieitis, ulcer, and eversion. Iodo-Tan- 
nin, 236, iodoform and tannin packed around 
the cervix is a highly useful remedy in ulcer- 
ation and other disorders. Nitrate of Silver. 
266, a long-used and highly esteemed topical 
remedy, but has been much abused. Carbolic 
Acid, 330, pure, on cotton-wrapped probe, is a 
safe and efficient application in endocervieitis, 
endometritis, and ulcerations. Vegetable As- 
tringents, 303, oak, heuchera, hamamelis, ru- 
bus, etc., in the form of strong decoctions, in- 
jections, or fluid extracts, undiluted. Glycerite 
of Tannin, 303, and Glycerin, 697, are useful 
in greater or less degree. 

Varicocele, and Varicose Veins : 
Ergot, 419, ergotin injected subcutaneously along- 
side the enlarged veins, an effective but painful 
expedient. The injection must not enter the 
47 



veins. Same expedient can be practiced in the 
case of any varicose veins in an accessible situ- 
ation. 

Variola : 

Water, 68, Cold Baths for fever, especially hyper- 
pyrexia. Quinine, 179, small doses as a tonic, 
full doses lor the suppuration, and antipyretic 
doses if the temperature is high. Ammonia 
Carbonate, 214, if there is manifest depres- 
sion, and especially during the suppuration 
stage. Chloral, 512, is highly useful and ne- 
cessary when there are high temperature, wake- 
fulness, and delirium. Opium, 529, for wake- 
fulness, low delirium, and adynamia. Carbolic 
Acid, 328, Besorcin, 349, Salicylic Acid, 341, 
and Bensoate of Sodium, 855, are from the 
theoretical standpoint valuable antiseptics and 
antipyretics. Iodine, 236, tincture, is applied 
to pustules to prevent pitting. Silver Nitrate, 
266, a pointed stick of, is inserted into each pus- 
tule to abort it and thus prevent the formation 
of a cicatrix. 

Vomiting : 
Alcohol, 4S3, iced champagne or brandy in small 
quantity frequently, will sometimes arrest vom- 
iting of pregnancy, of sea-sickness, of cholera, 
yellow fever, etc. Ether, 489. Chloroform, 493, 
a few drops frequently, will arrest some kinds 
of vomiting, as sea-sickness, passage of gall- 
stones, etc. Bromides, 542, are serviceable in 
cerebral vomiting, and in cholera infantum in 
children, and in some cases of reflex vomiting. 
Chloral, 512. highly useful in vomiting of sea- 
sickness, cholera, and reflex vomiting. Ipecacu- 
anha, 625. rarely minute doses, will arrest some 
nervous and reflex attacks of vomiting. Arse- 
nic, 150, drop-doses of Fowler's solution, will 
stop vomiting of irritative dyspepsia, of ulcer, 
etc. Hydrocyanic Acid, 5S8, can be prescribed 
in the vomiting of acute stomach troubles. Pep- 
sin, 90, Milk and lime- Water, 199, Bismuth, 
143, are proper in the vomiting of indigestion, 
of stomach inflammation, of acidity, and of 
acute intestinal disorders. Calomel, 250, very 
minute doses of, will stop vomiting in cholera 
infantum and in other intestinal disorders in 
children. Oxalate of Cerium, 288, is one of 
the numerous remedies for the vomiting of 
pregnancy. Nitrite of Amyl and Nitrogly- 
cerin, 596, are said to be very effective in the- 
vomiting of sea-sickness. Alkalies, 197, espe- 
cially the effervescent powder. Nux Vomica, 
39S, the tincture, will sometimes succeed in, 
atonic states. Carbolic Acid, 326, has remark- 
ably sedative effects, and will arrest the vomit- 
ing of acute stomachal and intestinal disorders ; 
it is advantageously combined with bismuth in 
an emulsion. Oxygen, 319. 

Vomiting 07 Pregnancy: 

Cerium, 2S8, is a good remedy if given in full 
doses. Iodine, 230, a drop of the tincture, of 
the compound solution, or of the compound 
tincture, may succeed when other remedies 
fail. Carbolic Acid, 326, may succeed, but is 
uncertain, and its odor may excite disgust. 
Calumba, 159, a lew drops of the tincture may 



738 



CLINICAL INDEX. 



quiet the stomach quickly, but it often fails. 
Ingluvin, 87, has been frequently successful; 
also, Pepsin, 90, but is less useful than the for- 
mer. Nux Vomica, 398, a drop or two of the 
tincture may prove beneficial. Arsenic, 150, a 
drop of Fowler's solution, sometimes acts most 
favorably. Hydrocyanic Acid, 588, often does 
good and often fails. Alcohol, 483, as sparkling 
wine, may succeed temporarily. Oxygen, 319. 
Whooping-Cough : 
Atropine, 439, is a good remedy when secretion 
Is profuse, and in the spasmodic stage ; decided 
physiological effects should be produced to have 
any curative action. Hyoscine, 451. Bromides, 
542, give relief to the spasmodic condition— to 
the whoop — but do not much moderate the 
violence of the disease ; Bromide of Camphor, 
456, seems to be more useful. Hydrobromic 
ether, 490, subcutaneously by stomach, or by 
inhalation. Chloral, 512, is very useful at 
any stage, but is most serviceable during the 
spasmodic. Castanea, 301, a decoction of the 
leaves, may be taken at pleasure, and with cer- 
tainty of some, although not marked, benefit. 
Nitric Acid, 100, sometimes benefits exceed- 
ingly, but is uncertain. Alum, 294, especially 
when there is a copious bronchial secretion. 
Lobelia, 585, when it acts as a nauseant, is 
most beneficial. Carbolic Acid, 327, by in- 
halation, seems to be a very valuable remedy. 
Benzoate of Sodium, 356, internally and by 
spray, is reported to be very serviceable. To 



these may be added Salicylates, Resorcini 
and other antiseptics. Lactucarium, 538, the 
sirup, is a useful vehicle for the exhibition of 
other medicines. Asafoetida, 460, a disagree- 
able but useful remedy, and may. be given 
freely to infants and young children. Hydro- 
cyanic Acid, 588, may be given during the 
spasm stage, but it is most efficacious as a 
remedy for the cough kept up by habit after 
the subsidence of the disease, and the cough by 
imitation. 

Worms. (See Parasites.) 
Eucalyptus, 163. Calomel, 252, an excellent 
remedy to expel the round worm, and is best 
administered with santonin. Salicylic Acid, 
340, has been used successfully against taenia. 
Anthelmintics, 654. 

Wounds : 
Lister's Method, 330, Water, 72, cold and hot, as 
a dressing for wounds, to arrest haemorrhage, 
and, in form of baths, to depress abnormal heat. 
Alcohol, 479, 484, an excellent antiseptic and 
astringent dressing, and as a remedy in pyrexia. 
Carbolic, 330, Boracic. 352, and Salicylic 
Acids, 345, used under the antiseptic system, 
to disinfect, deodorize, and to change the char- 
acter of wounds. Chlorine, 821. 

Writers Cramp : 
Metallotherapy, 292. Faradism, 385. 

Yellow Fever : 
Carbolic Acid, 329. Champagne, iced, 483. 
Turpentine, 663, for the vomiting. 



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